Musings on World AIDS Day 2011

Dear Friends,

Today is World AIDS Day.

HIV continues to be one of the most important communicable diseases in Nigeria. It is an infection associated with serious morbidity, stigmatization of the infected, high costs of treatment and care, significant mortality and a high number of potential years of life lost. Each year, many thousands of individuals are diagnosed with HIV for the first time, and tragically in 2011 – about 70,000 babies were born infected with HIV in Nigeria – a completely preventable situation.

But we talk about HIV/AIDS so much that no one seems to notice any more. So, I thought I’d spend today reminiscing about the moment I made the decision to leave clinical medicine, and pursue a career in public health; a decision initially driven largely by the emotions at one conference. I was halfway through my MPH programme (which at the time I considered a stop-gap measure) when I stumbled upon an opportunity to attend the XIII International Conference on HIV/AIDS that was taking place in Africa for the first time – the location was Durban, South Africa in the summer of 2000.

Nothing quite prepared me for this experience. It all started with the opening ceremony where a young man spoke. At the time, the political establishment in South Africa was in denial of the AIDS epidemic, and the world had accepted a situation that life-saving antiretrovirals would be out of reach to most people living in Africa. At the opening ceremony; Nkosi Johnson spoke 7 words that brought most of those gathered in Durban to tears – literally – when he said I am a very lucky little boy.” He had lost both his parents to the virus and was raised by foster parents. But he felt lucky because at the time of the conference he was South Africa’s longest surviving AIDS baby. He stood on the stage at Durban that day and begged South Africa to stop stigmatising people with HIV/AIDS. On the day, he shared the stage with the then President of South Africa, Thabo Mbeki, who at the time refused to accept that HIV caused AIDS.

Then at the first plenary, the Jonathan Mann lecture was delivered by Constitutional Court Justice Edwin Cameron, who was the first South African in a senior official position to disclose his HIV/AIDS status as positive. On stage he held the audience spell bound with his speech ending with the profound words  …”I am here because I can pay for life itself”.  In 2005 Edwin published Witness to AIDS, described as a “part-memoir, part compelling analysis” of his struggle with HIV/AIDS in South Africa. These two heroes re-defined for me what leadership really meant…..

At the conference there was a meeting of Nigerians attending the conference, an initiative of Mr Omololu Falobi (RIP). Just a year into our then new democracy, with a HIV prevalence that had just crossed the 5% mark, a new “National Action Committee on AIDS” etc, we were enthusiastic about defining the way forward. A wide variety of issues were discussed…an innovative plan to place the first 10,000 patients on ARVs, a new strategic plan, our poor research capacity and then raging  “Abalaka issue”. In attendance at that meeting included Prof. Maurice Iwu, at the time, an active researcher on alternative medicines for diseases (before his foray into election management he later became the IEC Chair) as well as Professor Idoko (The current DG of NACA). We sat around that table, in a meeting chaired by Professor Akinsete, and we left…full of hope. 

Today, 11 years later…little has changed. The HIV prevalence has marginally decreased to about 4% of the sexually active population. While a lot more Nigerians are receiving life-saving antiretrovirals, 95% of these are funded by donor funds. But, the Nigerian Senate has been busy! In less than a year, they passed the Anti-gay marriage bill, while the Anti-HIV stigma and discrimination bill has been sitting in their offices for over 7 years now….In many ways ….I sit back and wonder about the theme of that epoch making conference when advocacy for antiretorivirals took the centre stage and wonder if we in Nigeria are any closer to “breaking the silence”. Sadly not – we are still at a stage most countries were several years ago – clouded in stigma, looking for scapegoats.

Yet, the bottom line is that global leadership is nearly exhausted. Western countries are completely enmeshed in their own domestic politics and crisis management. Our government, professionals and our people must get beyond the soft money available “chop” from donor funds, as well as the short-sightedness of our stigmatising attitudes, prejudices and dogma, and face up to the challenges that lie ahead of us. It will not get better on its own, and we are simply not doing enough. Business as usual will not get us far….and that is all we have at the moment. 

Welcome to World Aids Day 2011.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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