In January of 2001, Mauritania, a country with one of the lowest reported HIV prevalence rates in Africa, took a step that Nigerian leaders neglected to take more than 15 years ago: The country's Senate held a Special Session on HIV/AIDS, inviting experts to speak on the nature of the epidemic, and to suggest ways to nip it in the bud, even as the epidemic ravages the rest of the African continent.
The Mauritanian Senate recognized the urgency of concerted action against the epidemic, and suggested the introduction of sexual education in schools as well as a privately managed national agency to play an advocacy role. It is a refreshing, bold step from a country about the size of a few local government areas in Nigeria.
Around 1989, when neighboring countries were reporting an outbreak of HIV/AIDS, Nigeria reported only 11 cases of HIV infection. Officials, unwisely and against every historical epidemiological trend, diverted attention from the virus, focusing instead on mosquitoes and malaria. As they did so, fuelled by apathy and delusion, the virus silently crept into the nooks and crannies of Nigeria, infecting millions and killing thousands.
Due to bad policy, many Nigerians will have to suffer, and many will die from the virus, barring the sudden development of an efficacious vaccine. Today, even if we take the grossly underestimated figures used by the Nigerian government, the country has a whopping 2.6 million HIV/AIDS cases. And this is primarily the result of callous inaction and arrogance on the part of government. Information was adequate, but officials simply refused to use it or even take it seriously.
It was a familiar pattern in many African countries, with the possible exception of Uganda and a few East African countries. Indeed, rather than begin early intervention to educate and stem the spread of HIV/AIDS, African countries initially engrossed themselves in a wasteful debate over the origin of AIDS.
It all probably started in 1985, at the First International Conference on Virus-Related Cancers in Dakar, Senegal, in which I participated along with the co-discoverer of HIV, Dr. Robert Gallo, and the head of the OAU Scientific Commission, Dr. Williams. It was at this conference that respected scientists articulated their theory about Africa as the origin of not only AIDS, but of many other frightening diseases also. For instance, Dr. Kevin De Cock argued that Ebola virus, Marburg virus and Lassa fever, all thought to be new diseases, "turned out to have been endemic in Africa." Meanwhile, Gallo aired his African-Monkey Connection theory.
Said Gallo at the Dakar Conference: "Viruses closely related to HTLV (Human Type Lymphotropic Virus), but distinct from it, have been isolated from Old World monkeys. This and other facts led us to propose that the ancestral origin of HTLV is Africa."
As I wrote in a syndicated column in 1985, to a people who, barely 20 years earlier were under the yoke of Western colonialism, the Africa-Monkey argument was another indication of racism by Western scientists. Therefore, because of our history of colonialism and slavery, the first impulse of African leaders and opinion formers was to defensively repudiate such Western claims with a display of nationalistic garb.
But while Africans were engaged in this needless debate, intense anti-HIV/AIDS efforts were going on in the West. Pressure groups were forming and national education campaigns on HIV were being launched everywhere.
In Nigeria in 1985, it was difficult to meet one person who did not view HIV/AIDS as a "disease of the white man," and the African connection theory as more evidence of the Western association of Africa with everything negative. Well-meaning people who dared to preach abstinence or condom use as a way to curb the spread of HIV were routinely laughed at as victims of malicious Western propaganda. In the prevailing environment, therefore, many did not see the need for behavioral change. Unfortunately, that attitude persisted for years. Yet, many science writers knew that a major outbreak in Nigeria, with its 100 million people, was only a matter of time.
Such was the prevailing attitude in Nigeria, and it was the principal reason the National Action Committee on AIDS (NACA) was not inaugurated until last year. The Committee's work is cut out for it, and the challenges are daunting.
Although the death of popular musician Fela Anikulapo-Kuti and the admission by his world-renowned physician brother, Professor Olikoye Ransome-Kuti, that the musician died of AIDS has promoted some awareness and encouraged the use of condoms, many Nigerians still remain unpersuaded. A survey of some Nigerians, selected randomly over two weeks in January 2001, suggests that many are armed with information about the disease. But even those who reported adequate knowledge said they did not see any reason to wear condoms because, "I do not sleep around" or "I know the people I sleep with." Less than 5 percent said they would consider voluntary testing, while the majority said they would rather not know about their HIV status in order not to be ostracized by friends and family.
That is not an irrational fear in Nigeria today. Fela's brother suffered unprecedented assault in the press by commentators who accused him of a criminal vendetta against the more popular musician. Worse than ostracism is the likelihood of an HIV-infected person being fired from gainful employment.
There appears to be no recourse in Nigeria for such people who are wrongfully dismissed from their jobs. In a shocking case that resonated throughout Nigeria, a judge on January 22, 2001, disallowed a former hospital worker, Georgiana Ahamefule, who was dismissed from her job, from appearing in her defense out of fear that she would spread the virus in court! Her case remains unresolved.
The attitude of the judge underscores a desperate need in Nigeria for a national education program on HIV/AIDS, along with comprehensive programs to combat the virus, including condom use, vaccine tests, counseling and treatment.
Political leaders should begin to speak openly about the virus and participate in public blood screenings. Of course, it is probably too late for 2.6 million Nigerians, who, unfortunately, will eventually become the cadavers next door. But far too many Nigerians remain at risk. And they must be saved.
Yinka Adeyemi is a Columnist for the Daily Times of Nigeria and author of "A Media Handbook for HIV Vaccine Trials for Africa" published by UNAIDS.
Back to the GMHC Treatment Issues September 2001 contents page.