A dozen men and women crowd the entrance to an unmarked upstairs clinic in one of Lagos’s main hospitals while others sit patiently outside a special pharmacy. A sign nearby directs patients in the opposite direction, to the ”fee-paying government hospital pharmacy” — but this discreet dispensary, run by Médecins Sans Frontières, is free.
The clinic and special pharmacy have no nameplates in order to prevent other patients realising the waiting people have come for HIV tests or have already been confirmed as HIV-positive. The stigma of HIV is still strong in Nigeria.
The clinic’s clientele is growing fast. At the end of 2004 only 40 people were on the books for anti-retroviral drugs. Now there are more than 1 000. Yet, astonishingly, apart from a smaller project supported by the United States government in a different Lagos hospital, this MSF project is the only one providing free testing and ARV drugs — and this in an oil-rich country where millions of people are HIV-positive.
Nigeria’s federal government receives millions of dollars a year from the Global Fund to fight Aids, Tuberculosis and Malaria — the international financing body set up in 2002 — but the government insists people pay part of the cost of HIV testing and treatment.
MSF hopes to alter this. Its clinic and pharmacy in Lagos are intended not just to treat HIV but to serve as a campaigning tool. ”Our overall objective is free comprehensive care for everyone. We have to make this project a driving force for activism and a pain in the backside for government,” says Tobias Luppe, MSF’s access campaigner in Lagos.
In April MSF and 11 NGOs wrote to Nigeria’s President, Olusegun Obasanjo, thanking him for ”championing the treatment, care, and support of people living with HIV” and for providing subsidised ARV drugs. But unless treatment was completely free, they argued, many would drop out and die.
MSF’s research shows that 80% of those who give up taking the drugs do so for financial reasons. The government’s minimum charge of 1 000 naira (about $7,70) for a month’s supply of the drugs, plus the cost of three appointments for laboratory monitoring a year and transport to the country’s few clinics, add up to an average of more than 100 naira a day, the letter said. Two thirds of Nigerians live on less than 140 naira a day.
Nigeria introduced fees for healthcare in the 1980s under an economic programme recommended by the International Monetary Fund. In July this year MSF brought together a group of local NGOs to create a Treatment Action Movement, campaigning for Nigeria to go back to a free health service, starting with HIV. ”Our president signed a UN declaration in 2001 pledging to spend 15% of the national budget on health. Four years later it is only 5%,” says Omololu Falobi, director of campaign group Journalists against Aids.
The group, part of the Treatment Action Movement, holds seminars and workshops in newspaper offices on how to report Aids issues. Youth Action Rangers, another NGO that MSF works with, visits schools and youth clubs to explain safe sex.
MSF Lagos mainly employs HIV-positive people as staff. They run their own awareness and prevention programme at the clinic. ”Self-stigmatisation is the worst thing,” says Ibrahim Umoru, one of the counsellors. His wife left him when he was diagnosed as HIV-positive. He runs a support group and at one recent session I watched him tell the group: ”I found I had been living with a stranger. I thought she loved me. HIV really shows what love is. At weddings the pastor asks the man and the woman if they love each other, and they say ‘Oh yes’, but neither knows what love is. HIV gives the real definition.”
Other clinic employees go on Sundays to meet young people at the New Afrika Shrine, a club and concert hall erected in memory of Fela Kuti, the international music star and founder of the Afrobeat movement who died with Aids in 1997. Wearing an MSF ”Free Treatment Now” T-shirt, Hassana Adams, the clinic receptionist, sat down one Sunday at the club with a group of men in their 20s. They were not going to turn away an attractive young woman. Producing packets of condoms which she later handed out, she fitted two on empty beer bottles to show how to use them. There was no laughter. The men were genuinely intrigued. She urged them to come to the clinic for a free blood test.
While criticising the federal government for charging for treatment, MSF Lagos works with it as an adviser on contentious international trade issues such as branded drugs and advises the government where to buy the best generic drugs and condoms. The database of MSF’s ARV users is being used for World Health Organisation research on what happens to the immune system if treatment is interrupted, even for a few days, and what mutations and resistance to the drugs this can cause.
In 2006, MSF Lagos hopes to increase its budget to $4,3-million, from $1,9-million this year. ”We expect to raise the number of people getting ARVs to 1 700 by June,” says Els Standaert, project co-ordinator.
Tobias Luppe says there is little danger increasing MSF’s clients will encourage the federal government to leave the problem to charity. ”We’ll never make a difference in terms of numbers,” he says. ”But we need to have a strong clinic to give ourselves credibility with the government and local NGOs. We have to be a model for best practice and a catalyst for change.” – Guardian Unlimited Â