Today, December 1st, 2005 is World AIDS Day. Far too many of us Nigerians have to live with the consequences of HIV/AIDS every day - the pain, the sickness, the death. But World AIDS Day is an opportunity to reflect also on the causes of the pandemic and on potential solutions.
Here in Nigeria, the fundamental reason for our terrible problem with HIV/AIDS is simple: poverty is the disease’s best friend. It is poverty that provides the circumstances under which the disease thrives, killing thousands of our sons and daughters each month.
Throughout the world, education has proved the most effective tool in bringing down HIV infection rates. In Uganda, in particular, infection rates halved over a decade of government campaigning to ‘Abstain, be faithful, or condomise’ - the so-called ABC method.
But education is undermined by poverty. Parents, unable to afford fees, remove their children from school, so they do not learn about the causes of HIV and methods of prevention. It also puts them at a disadvantage in finding employment. Few opportunities exist for the thousands of children who are deprived of an education. Many young people turn instead to a life of drugs, crime or prostitution: lifestyles in which the HIV virus flourishes.
Nigeria’s terrible crime rate is directly attributable to poverty. The general social malaise, discontent and frustration apparent in many of our towns and cities, in which people start riots and destroy properties at the slightest provocation, has created a climate of fear. People flee their homes for safety, gathering in refugee camps that lack proper facilities. In these camps, hundreds of young men and women are thrown together with little to do. The camps have become breeding grounds for the HIV virus, as well as a range of other sexually transmitted diseases which increase the risk of infection.
The relationship between poverty and AIDS is not all one way. Just as poverty encourages AIDS, so AIDS encourages poverty by attacking the economically active section of society. This is not a disease that attacks the old or infirm. It targets those of working age, the parents and breadwinners, leaving destitute orphans with no role models. Thus whirls the destructive cycle of poverty, disease, death and social disintegration.
Drugs exist to mitigate this particularly corrosive aspect of the AIDS pandemic. With the right anti-retroviral medicines, HIV/AIDS patients can lead relatively normal lives, alleviating the symptoms of the disease and delaying death for decades. But once again, poverty is death’s handmaiden, denying access to those medicines, which even at deeply discounted prices are too expensive for people who can barely afford a square meal each day.
As a result of poverty, people not only cannot afford drugs, but cannot even afford transport to a hospital. Instead they go to local pharmaceutical stores to buy medicines from unqualified vendors, who often peddle drugs that are counterfeit or sold at the wrong doses. It seems incredible that people should send their sick child to these quacks. But due to the constraints of poverty, this is a necessity rather than a choice for many Nigerians.
So what is the government doing to address AIDS? Its track record is abysmal. In the early 1980s, politicians and academics denied the presence of any HIV infections in Nigeria, which fatally delayed the kind of public response which successfully curtailed the disease in Uganda.
More recently the government has set up less than 20 medical centres to disperse anti-retroviral medication. But there is no way the centres can ever hope to deal with the estimated 3.8m infected Nigerians. They cannot even cope with the population of Lagos alone.
The government also claims to subsidise the cost of anti-retroviral drugs, but in reality only one per cent of all HIV/AIDS sufferers in the country benefit from this. Even those lucky enough to have their medicines subsidised by the government still pay US$7.70 a month, which is prohibitive for the 70% of our population who live on less than one dollar a day.
Besides, government-run medical centres and subsidised drugs are merely sticky-plaster policies, which fail to address the root cause of the crisis, which is poverty. It is our nation that is sick, not just individuals. Our leaders need to focus on wealth and job creation and on improved education that will give Nigerians a better chance of both.
Instead the government has merely paid lip-service to poverty reduction. It has instituted a whole host of bureaucratic schemes ostensibly designed to eradicate poverty. But its grandiose plans are paper tigers and amount to little more than a job creation scheme for civil servants, since none of their recommendations is ever implemented. Government officials attend one poverty reduction seminar after another, jamborees which allow them to stay in nice hotels but generate more talk than action.
The people of Nigeria long for the day when the government takes positive action instead of sitting on its hands. Ironically, the best the government could do would be to leave well alone. What Nigerians need is not mismanaged government health initiatives but policies that encourage economic activity and increase prosperity. The link between wealth and health is evident. In rich countries HIV prevalence is low. With wealth, the people can educate their children, afford medicines and healthcare, and lead more productive lives.
Our leaders should concentrate on creating the conditions in which people can lift themselves out of poverty. This means liberalising the economy. They should encourage entrepreneurs by making it possible to set up a business easily, without the choking bureaucracy and the large amounts of money required at present. They should make it easier for people to own property so that they can invest in their own future.
They should reduce barriers to trade and open the market to competition, both internally and externally. These policies have been shown again and again to increase economic activity in the West and the Far East. They could do so in Nigeria as well, with extremely positive results for the health of the population. Since we cannot rely on our government to help us fight AIDS, they should give us the chance to help ourselves.
Oluchi (info@ippanigeria.org) is a volunteer with the Institute of Public Policy Analysis in Lagos, Nigeria