Thought Leadership

….Did you notice the 15th ICASA?

ICASA? …the 15th International Conference on AIDS and STIs in Africa

…you did not notice?
From the the 3rd to 7th of December Africans assembled in Dakar, Senegal to take stock of the science, political commitments, unfulfilled promises and actions and practices employed in the fight against HIV/AIDS.
You will be right if you notice that this is an abnormal year for an ICASA (it is normally held the year between the International AIDS conferences). The conference scheduled for The Gambia in 2007 had to be cancelled when the Gambian President Yahya Jammeh announced he had discovered a cure for AIDS! (no joke). He made that announcement in front of a group of foreign diplomats, telling them the treatment was revealed to him by his ancestors in a dream.
So the honour fell on Senegal!
Sadly we hardly heard a wisper about the conference in the press, local and international.
BUT …the good news is that Nkem attended! ….and sent us her take on the conference from a very Nigerian perspective….ENJOY!

Thoughts on the recently concluded ICASA meeting

I was recently in Dakar, Senegal to attend the International Conference on AIDS and STIs in Africa (ICASA). During the 5 day conference, we had beautiful weather in Dakar and we couldn’t have asked for better since the conference was both inside the Le Meridien President hotel and outside on its grounds.

I must begin by sharing with you that this was my first ICASA meeting ever. I have no experience to compare it with other can my expectations and experience attending other conferences on HIV/AIDS and other conferences in general, in Africa. Prior to arriving in Dakar, I was impressed by the conference organization. Before arriving in Dakar, my interaction with the ICASA organizers was smooth especially given that I speak no French.

However, on the first full day of the conference (the opening ceremony was the night before), December 4, I arrived early to check-in and pick up my conference goodies (bag and guides). That’s when the problems began. They had run out of bags!! It was 9:30AM on the first official day of the conference, I had pre-registered almost 3 months earlier, and there was no bag or abstract book for me. It turned out I was not alone. There were a few of my colleagues hanging around who had arrived earlier that morning who were also without bags or abstract books. The best we had were little foldable presentation sheets with the session names, but with no information about the topics being presented and who was presenting. As a result, I attended a session titled “Community-based involvement in prevention”, but the first two presentations were on “building stronger African civil society participation in policy advocacy in Africa” and “Primary caregivers – the critical but hidden hands in HIV/AIDS care”. After the first two presentations, I discovered that the session title didn’t exactly fit the presentations and not what I had expected to hear. If I had the bigger book with the presentations actually listed at this time, I would have been able to better select the sessions of interest to me. After this session, I went back again to the check-in desk in search of the book that listed the presentations in addition to the session titles.

It turned out that the ladies at the check-in desk were hording the bags and books. It was the oddest thing. While I was standing around waiting for the bags to come (in a hour as I had been assured), I would see some people go up to check-in and come out with bags. I would go back only to be told there were no bags. Apparently depending on whom you spoke to (the ladies attended to different people according to the last names) you could get nothing, just a bag, or everything! And also, depending on how you smiled or asked. I am not sure. I checked-in about 9:30AM, got a bag about 1PM, and finally managed to get an abstract book, or rather presentation book listing the presentations in each session, at about 6PM. The book didn’t have the abstracts as we thought. Technology has taken over, so we got the abstracts in CDs, but if you wanted it in hardcopy for convenience, they were on sale for approximately $10 (5000 CFA). And this was only beginning on the second day as we discovered when we saw the stands open up on December 5.

Despite this little frustration, the conference was a good one for me although I have a few comments regarding my impressions, good and bad.

For one thing, there was a large representation of the disabled HIV/AIDS community at the conference. I have not been to an AIDS conference in a few years, but it was interesting and good to see this group so visible and well represented and participating, at the conference – in wheelchairs, blind, etc. There were also a number of interesting sessions on the topic. One I found particularly interesting which is related is the relationship between mental health and a person’s HIV/AIDS status.

From what I was able to tell, most of the abstract submissions were accepted as poster presentations, with certain groups either being invited or organizing special panels to talk about their research orally. A number of the oral sessions were sponsored by groups such as Amref, Fogarty, Global Fund, etc. A couple were on actual scientific research but more on reports from interventions, but there were some really interesting results from scientific research being conducted by institutions in the West. Unfortunately, this is where most of the high quality research was presented. It struck me that African groups conducting high quality research might not choose ICASA as a forum to share their results and may want to attend more pres
tigious conferences which larger media coverage to disseminate their findings. I don’t recall ICASA being mentioned on CNN the week of the conference. The problem with this is that most of these conferences are held in countries that most Africans have difficulty traveling to easily due to travel restrictions, as well as the major issue of most of these countries, including the US, not permitting HIV positive people entry into these countries. So the African audience is very limited at these ‘prestigious’ conferences, when they might be the ones to benefit most from the results being presented there and should be the ones hearing the information for several reasons including the fact that their communities provide the subjects which are being studied.

For my group, we were attending ICASA not to present any findings from our research, but rather to be challenged by what other researchers in Nigeria and Africa were doing. Unfortunately we came out feeling very good about our study methodology and progress, even though we know that there are a number of areas we can improve on. This does not say much for the research presented at ICASA, especially research from Nigeria. There were only one or two notable oral sessions on studies conducted in Nigeria. At one of these sessions, there were to be three presentations from Nigeria in that session titled “Determinants of the HIV Epidemic: where do we need to focus?”, however, only one showed up. A researcher at UCH presented on the “sexual practice among people living with HIV at the UCH, Ibadan, Nigeria” after they begun to receive ART. When he was challenged as to the point of the study, given that we all know that when someone is weak it can prove difficult to be sexually active and treatment that leads to feeling stronger could lead to increased sexual activity, the same with malaria or any other weakening illness, he could not defend the study. The study also found a slight increase in the use of condoms by the study subjects, but there were free condoms at the treatment center, so if people took condoms when they came for treatment, then it only seemed logical that they could see an increase and a very slight increase in use of condoms. A useful follow-up question in this study could have been for the researchers to find out where the respondents reporting increase in use of condoms where getting their condoms. Were they going out to purchase condoms or just using them when they happened to get a few free ones at the hospital?

All other Nigeria presentations were poster presentations, of which more that half did not show up. At least they were not there when I did my rounds and I made sure to circle all Nigeria studies in the book before I went looking for the specific poster numbers. Some put up their studies and were not there to talk about them, while for most, the studies where not put up at home. There are a few pictures of some studies that were there. I won’t really comment on them, but I personally thought the topics were already over studied and provided nothing new, or that certain high government officials shouldn’t be presenting very simple poster presentations. That’s just me though.

Back to the research sessions from the West, it was interesting to me that the audience was largely western. There were very few Africans in these sessions, which could be explained by the fact that a majority are still studying condom use and sexual behavior, and are not interested or aware of other more complex issues such as “how and why does infection with different subtypes impact on the neurological diseases associated with HIV-1 and HIV-2?” Even a great presentation by the APIN/Harvard group on the different types of HIV and their subtypes, only very few Africans were in the room. And I have to admit, this session was one of the most intriguing sessions to me and one I thought people could learn a lot from especially in understanding why sometimes ‘AIDS dey show for face’ and sometimes ‘AIDS no dey show for face’, or why you could have unprotected sex once, and become infected, or why in some cases people can get away with having unprotected sex on so many occasions. It could all come down to the HIV type or sub-type infecting the person’s partner and how easily it could be transmitted or develop to AIDS.

Although I didn’t feel like Nigeria represented very well at the conference and some of the organizing could be better, I did enjoy the conference and took away a great experience from it. Learning can come in different ways, and I did learn that we could challenge ourselves more in Nigeria to study HIV/AIDS topics that move away from condom use, sexual behavior, awareness, knowledge and maybe try to find out more why someone thinks they are not at risk of becoming infected, but in the same breath believes that HIV can be transmitted by mosquito bites and touching PLWHA. One poster actually presented this and when I asked her how it was possible – did these people not take public transportation or live in an area where there were mosquitoes, I risked being a sarcastic audience member and I politely acted like it was a joke.

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

By Chikwe Ihekweazu

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.

4 replies on “….Did you notice the 15th ICASA?”

The Nigerian Health Watch is doing well to update us globally in all Nigeria events. I am a Public Health Specialist at the Hebrew University of Jerusalem, Israel. I am a Nigeria and would want to appreciate Nkem for attending the ICASA. I used this opprtunity to know why I have not received materials from the ICASA from my friend because maybe like Nkem, he did not get.
My comment here is that Africans have not realy started facing health issues with passion. Research cannot go on because we lack not even the material resources but the human competence. How many institutions in Nigeria have you heard conducted a cutting- edge research?. I do not believe that their is no money to conduct research in Africa because thare are a lot of foreign grants floating all over the world which I can list them here. Our new Minister of Health in NIgeria: Prof. B. Osotimehin did a lot of interesting and cutting-edge researches with foriegn Scolarships/grants during his years in the University. Look at his profile. He was getting the funding because he knew what he was doing and realised the importance of the research at that material time. He also showed high levels of accountability and transparency in the management of the Scholarships/grants given to him then in the University, and he continued to get. Now he is using it to contribute his quota towards the development of the Nigerian Health Systems. Everybody is aware of the high levels of achievement and results recorded by Prof in NACA before humbly accepting to serve again as the HMH FMOH, FRN. So people can consult him and ask him the way(s) forward. The challege with foreign scholarships/grants is that your proposal must be academically sound and convincing to be providing new knowledge to the existing one before the panel can consider you. Africans lack the knowledge; and research grant writing is not just to run through the WHO statistics in your country and submit to international Agencies and collect money. We need to reform our system. Invest money on human capacity building in research and development.
The issue of endemic corruption and greed cannot be over stressed. You may notice that most people at that ICASA came because of DSA/DTA and Honoraria. Ask them what was the main objective of ICASA, they do not know.
We need to stop and ask ourselves question of what is our contribution to the development of human knowledge in our respective countries. The Westerners are going on with research not because of the money but because of name by contributing to making this world a better place. I am here as an international scholar in Biomedical Epidemiology and Gene Silencing with an international grant. One of my Professors Emeritus here got a multi- billion dollar grant for a research on the Gene for antibiotic resistance before the era of resistance came in. We are talking of research that is looking back to both premedieval and medival periods. This is because of the world problem now with antibiotic resiatance especially MRSA. Our research is focusing maily on TB and HIV drugs. So you can understand where people are and we in Africa cannot do that because we lack the technical expertise. Let us not focus on local funding both for our reseach education and research grants. Google the internet and you will be happy with Globalisation and wealth of information.

Dr. Ezikeanyi Sampson: MD, MPA, MPH
Legacy Heritage International Scholar,
Hebrew University- Hadassah.

Sent in on behalf of
Dr Joseph Ana
former Commissioner for Health (July 2004-June 2008)
Cross River State of Nigeria.

Low quality research from Nigeria and Low presence of Researchers ( even those whose papers were accepted)
Thank you for circulating this conference report, which makes very interesting reading.

I wonder if the President of The Gambia is better informed now. I think it was a mistake to take the meeting to Senegal. The meeting should have held in his country so that he and his population could have been educated on HIV / AIDS. It is a lost opportunity to have taken it away. See what happened to former President Mbeki of south africa who held similar views as his counterpart in The Gambia, for many years. Towards the end of his reign or immediately after he left office, South Africa policy changed because majority of the people had been educated over the years by stakeholders in HIV / AIDS who pesevered and stayed on in that country, inspite of the ignorance of the government. The world did not abandon South Africa because the President was ignorant ( or so it appeared) judged by his utterances and the policy of his government.

We in BMJ West Africa edition (BMJWA) are really not surprised that the papers from Nigeria at the last ICASA in Senegal were short on quality, if judged by ‘what new knowledge they generated’, because BMJWA has difficulty getting papers submitted to The BMJ to pass the robust peer review scrutiny. Many local Authors think it is all about ‘western bias’, but infact our experience since we started publishing BMJ West Africa in 1996, in Lagos, is that the submissions are often mainly about number crunching ( how many cases of diseases X are seen in Y teaching hospital in Z geopolitical region of the country). It is difficult to get the Author(s) to say how their paper will ‘add to existing knowledge’ in the management of the condition, or much less ‘present a new management’.
There are several reasons for this difficulty, including the lack of facilities for conducting proper original research because there are usually no laboratories or libraries worthy of the name; decades of underfunding has meant that CPD / CME across the professions of health is virtually dead in most locations – other ‘priorities’/ ‘demands’ take up the little funding that is available; lack of interest on the part of the practitioners (indeed, as the BMJWA was organising one CPD meeting in 1998, we were asked ,’ whether na research we go chop? And this came from very senior doctors); some person/authority killed the one-year abroad programme for resident doctors in Nigeria, which used to give the opportunity for these senior residents, who in time became the chiefs executives, lectures and policy makers on health, to interact with their colleagues around the world ( mainly Europe and USA). The practice in Nigeria has become ‘protectionist’ and ‘isolated’ from the positive exposure that Globalisation presents; etc.

The BMJ West Africa edition recognised these short comings soon after it released its maiden issue and has commissioned a number of initiatives to empower/enable locally based practitioners/ colleagues to establish useful contacts for international exchange of ideas, research methodology and findings. In 1998, it started the ‘Workshop on How to read, How to write and how to get published’ ; In 2000, it started the ‘Workshop on critical appraisal of papers and how to apply research findings appropriately and in context of local practice’; In 2002, it started the ‘Masterclass series of Lectures’ where a senior expert in a particular field/ specialisation will tell the audience of peers and juniors ‘how he / she did it’, ie. how they became masters in their field ( former masterclass lecturers include Prof Richard Smith ( medical writing), Late Prof Lambo ( ethical practice), Prof Idris Mohammed ( immunisation), Prof Ezedinachi (malaria), Prof Uduak Archibong (inter-professional collaboration).
The 2008 Masterclass Lecturer is Professor Dora Akunyili (the important role of effective communication in health promotion).
The BMJWA in collaboration with the Ministry of Health of Cross River State piloted, ‘Clinical Governance, Reserach & Training in Health Initiative from 2004 to 2008.The positive outcome of which was adopted by the National Council on Health of Nigeria at its 49th meeting ( Jalingo 2006) and 50th meeting (Abuja 2007).
The initiative is currently being applied to Bauchi state health service in collaboration with the present state Government of Malam Isa Yuguda.. It covers CPD / CME including building capacity for medical research, audit and writing.

Let us hope that with the immediate past D-G of NACA now the new Federal Minister of Health, Human Resource Development including Clinical Governance, Research and Training will take its deserved centre stage from primary to secondary to tertiary levels of the health care system in Nigeria.
Because, as we say in the BMJWA, ‘no matter how beautiful the buildings that house hospitals and health centres, and no matter how sophisticated the equipment ( MRI and CT scan included), it is the Knowledge, Skils and Attitude to patients of the practitioners that will prevent and reduce morbidity and mortality.’

Dr Joseph Ana
former Commissioner for Health (July 2004-June 2008)
Cross River State of Nigeria.

Dr. Joe, thank you so much for this piece. That is why I will continue to say that information is needed to keep pace with the rapid Globalisation. I never new we have such a forum in Nigeria/Africa.
Meanwhile, I wish everybody a happy Season. Here we are celebrating ‘HANUKAH’ here in the old city of Jerusalem where creation is believed to have started depending on your faith and which story you listen to. This has its origin from the creation as recorded in the Bible. It simply means ‘ kNOWLEDGE/EDUCATE’ and then related to ‘LIGHT’- first creation. Put together, it all means that light is (or gives) knowledge and knowledge is power. We need to light up the pathways of research in Nigeria for effective delivery of National Development Goals in accordance with the Global Standard. I would want to recommend that we look at other alternatives of funding research and Development (R&D) in Nigeria since there are many political priorities competing for the small budgets. As good managers, lets scan our environments and leaverage other potential strengths around us. I stated it in my initial comments that there are many grants floating and used myself as an example that I am here on an international postgraduate/postdoctoral research scholarship. Many others are there. The Joint/Japan World bank research scholarship is there every year and proposal/application is being accepted now. The Fulbrigt research scholarship is there. In JohnHopkins University, Africans have the- De Beers Scholarship if you prove outstanding. Harvard has a lot for Africans. I think our problem is the idea of remaining in ones comfort zone. Before I joined this prestigious worldclass Research University, I was and still remain a senior staff of the Federal Ministry of Health. I will come back later and utilise the knowledge in Nigeria. I will not go back to America because it is an American Organisation that is funding me.
So, lets utilise these opportunities and move away from our comfort zones and embrace the new innovations.
I would want to link up with the BMJ Africa if Dr. Joe could send me the links.

Dr. Ezikeanyi Sampson: MD, MPA, MPH.
Health Policy, Epidemiology & Biostatistics,
Hebrew University-Hadassah

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