By Shola Oshunkeye
Goosby, who was sworn in on June 23, 2009, and had served in the President Bill Clinton Administration, also leads the new Office of Global Health Diplomacy at the U.S. Department of State.
I spoke with the man, who leads all U.S. Government international HIV/AIDS efforts, on his visit to Nigeria and the focus of the AU conference.
Excerpts from the interview:
Since you just got in yesterday, it would be quite unfair to ask about how you feel about Nigeria. But is this your first time here?
I have been here several times. This is just a ready response. Nigeria has been one of the most remarkable countries for me. Nigeria is one of the oversea countries in Africa that has been impacted by HIV. I have also seen other countries as well that are also impacted by HIV. That’s part of my job: to understand how this epidemic has moved globally. Nigeria has been a difficult country to develop a response that impacts numbers of new infections, bring people who are already HIV positive into services and keep them in services over time. Of the 420, 000 babies born, HIV positive, on the planet, Nigeria now has 60, 000. Although there has been a drastic reduction, we are not going to be successful with preventing mother-to-child transmission ending pediatric HIV without Nigeria also ending it. So, over the last two years, we have worked with your government and with the state governments to understand better how to support a medical delivery system that effectively identifies and retains people on care over time. We found that doing it stage-by-stage and not trying to make a national response or only quick effort, but acknowledging the social-political divisions that the state represents, are important. Changing our strategy to a stage-by-stage approach has enabled us to be much more effective at getting those hard-to-reach population.
And that is a huge population considering the fact that there are some 170 million Nigerians within this geographical boundary. Is this huge population a hindrance, or how has it affected the HIV response?
Good question. The response, in the last two-and-a-half years, has increased significantly. And it is done by your political leadership acknowledging the disease in a different way, more grassroots way, prioritizing that in his discretion with governors, first ladies of the states, as well as his wife. In the last two years, I have seen Nigerians move mountains. They have done far greater than they had in the last eight years prior to that. So, I am optimistic this is a real change in the way your government is going to relate to HIV and health in general.
Isn’t there a particular area you want us to improve? Isn’t there an area where you want to see better effort?
I think Nigerian has been trying by moving resources to programmes, getting enough implementers funded to put a strong programme in place. Not being able to mobilise the money as rapidly as they should has been the problem. But this government has understood and acknowledged the problem. And it is now trying actively to minimise the kind of bureaucratic barriers to putting programmes on ground, acknowledging that each state needs to take ownership of their own medical systems. It is okay for a state to have a little difference from another state. They don’t all have to look exactly alike, and the government embracing that has given us a real opportunity to see more people being brought into care. More people are being retained in care, fewer people are dying, and in the next two years, I am confident that the number of new infections in Nigeria will start to drop.
Is there a national benchmark expected of countries in terms of budgetary allocation to tackle the disease?
The benchmark that the African countries themselves set for themselves was in the Abuja meeting 12 years ago. At that meeting, they set 15 percent as the benchmark. We believe that is about right. We think that countries need to decide that investing in the health of their people is a smart investment; and that, matched with education, is the critical role the government must play. And I think Nigeria is beginning to really not just talk about it but also showing its resolve.
I know you shoulder a huge responsibility with your involvement in the Obama Government’s fight against HIV globally. What drives you in all your trips abroad, everywhere you go?
What drives me is, first and foremost, I am a physician. I have treated this disease since 1981 and have seen hundreds of people, during my own practice in the United States, die from HIV because they didn’t have access to antiretroviral drugs. At the time, there weren’t antiretroviral drugs that were effective. We did a lot of research to find those drugs. Now that we have effective drugs that can truly put you in a position where you should die from something else, I became driven to make sure that those who are HIV infected would, indeed, benefit from these medications. That’s the main drive. I see Nigeria shifting into high gear.