Issues about HIV/AIDS have continued to provoke tremendous pain and passion. Since the dawn of this year, I have been inundated with calls and mails over Nigeria's HIV/AIDS profile. Some of these came from Nigerian health experts, in formal and informal interactions here in the United States. Others stem from a pool of opinions from the Non-governmental Organisations (NGOs) as well as Nigeria-based health professionals  concerned about the pandemic in the country.

 

These responses, to a large extent, reflect the views of thousands of citizens, many of whom are suffering in silence, lacking access to adequate resources for public expression on this very sad epidemic. A cursory overview of these divergent opinions indicates that the poor management of the crises is also driven by the same factors that have kept the country in abysmal poverty and underdevelopment, notably corruption and bad governance which are widely acknowledged as the bane of this giant of Africa.

 

  Without doubt, last year’s alleged   use of expiring drugs remained the most controversial going by the passionate outbursts of respondents:

 

 Uzodinma Adirije of Afrihealth Information Projects expressed much anger over the use of expiring ARV drugs. Her views:

 

‘The very act of sending expired or expiring drugs to Nigeria is an exhibition of discriminatory practices at a wicked level, and to think that some money - no matter how small - might have been spent by the Nigerian government and or people for acquiring such medicines is incredibly scandalous.’

‘There should be no reasons why humanity and its agents would deem expired and or expiring drugs unfit for one population and fit for other. There is no healthy reason to accept that expired drugs as useable in Nigeria as long  as six months after expiration, and not in Holland.’

 

In venting his  anger, Adirije alluded to a  Nigerian proverb which says: "if you are carrying me on your back and my legs are touching the ground, it is definitely better that you bring me down so that I would walk the distance on my legs".’

 

Nigeria is "resource-poor" because we have governors, ministers, parliamentarians and presidents whose wives must float 'NGOs' as soon as they come into office, use them to usurp the proper functions of various ministries and receive moneys from various public/private organizations and contractors without being accountable to the state and our people; whose children must become multi-billion Naira contractors because of their parents' new positions; and whose families must never lack any thing that money can buy simply because their own person has held such a public office in this country,’ Uzodinma concluded bitterly.

 

Similarly Dr Chidi Nwaneke of Project Shop described the act ‘as a camouflage for the hypocrisy of the West. Why should any human being with a conscience wait until a drug is expired or about to expire before 'donating' it to another person?’ He continued:

 

‘It is a shame that this can happen to a country like Nigeria – a country that has no business 'begging' for money but which has to beg for money to survive. I do not in any way blame the western 'donors' but our greedy and myopic leaders.’

 

‘Perhaps expired drugs can be of some use to beggarly countries like Nigeria but the inventors of expiry dates are no fools. If the government should overtly or covertly sanction the dumping of expired and expiring drugs in Nigeria in the name of ARV drug donation, then NAFDAC has no business existing; and the Onitsha traders should be compensated,’ he posited.

According to Dr Joan Okafor, a US-based gynaecologist, this is a reflection of Nigeria’s poor health system. Or where else in the world can this happen. We need to put our house in order in order to forestall this kind of malady, she remarked with a sigh.

 

Dr Michael Fleshman of Africa Recovery condemned the unfortunate incident in very strong terms. ‘I assume that expiration dates are there for a reason, namely that medicines lose their potency after a certain amount of time.’ ‘I scarcely think the issue is one of national vanity, although it is certainly true that Africa has been used as a dumping ground for all kinds of dangerous chemicals, including expired, defective and counterfeit medicines -- practices which should never be condoned in Africa or anywhere else.’

 

‘The very worst outcome would be for people to take ineffective medicines in the belief that they are being treated, and then discover that they are not. This can only discredit and damage vital treatment initiatives and reinforce the credibility of charlatans and criminals who are all too willing to exploit peoples' ignorance and desperation with fraudulent, unscientific and potentially dangerous "cures".

 

’‘With prices for generic ARVs down, at least in theory, to 70 cents a day, via the Clinton pricing initiative, its hard to believe that Mr. Thad Wendel's   defense of expired medicines makes economic or ethical sense. ’‘Shame on Nigerian health officials for failing to ensure a reliable and adequate supply of quality medications.  That, I think, is the real issue, not whether Western castoffs are still good for a few weeks or months after the expiration date.’

 

The crisis according to Olayinka Akanni of Journalists Against AIDS (JAAIDS) began when supplies of drugs to some of the treatment centers ran out, due to a breach between the Nigerian government and the Global Fund forcing care personnel to issue out expired batches or direct clients to make their own purchases at commercial rates in the private market.

 

Akanni continued his account: ‘In August, Akanni, people living with HIV (PLWH) on the treatment programme across the country, who usually receive drug supplies in three months stocks, noticed that some ofthe drugs carried expiry dates of October 2003.Some of the drugs reportedly dispensed included Nevipan, a brand name of Nevirapine manufactured in November 2001 and expiring October 2003;Avostav (Stavudine), manufactured in 2002, expiring in 2004 and Avolam (Lamivudine) manufactured in 2002, expiring in 2005. All the drugs were manufactured by Ranbaxy, India.’

 

It was also learnt that in one of the hospitals, a pharmacist remarked that ‘expired drugs are safe for up to six months after the expiry date stipulated by the manufacturer’

 

‘Oba Oladapo of the Positive Life Association (PLAN) based in Ibadan, Oyo State, was one of the first to notice the anomaly, after he received complaints from other PLWH accessing drugs from the University College Hospital, Ibadan, an ARV treatment site. He reported to members of the Treatment Action Movement (TAM) and NEPWHAN, who promised to look into the matter.’

 

In the words of New York-based Fleshman, this is not only a national shame, but a travesty that should never repeat itself.