Prevention is an outcome, not a programme. It is a mix or combination of programmes and policy actions which are structural, biomedical and behavioural. Combination prevention therefore is coordinated to work synergistically on underlying risks and vulnerabilities. This was the view of Dr.   Barbara de Zalduondo who represented UNAIDS at the 5th National Conference on HIV/AIDS in Nigeria that held 2nd to 5th May 2010. She was the first presenter at a Special Session organized by the National Agency for the Control of AIDS (NACA) with the theme “Prevention: Are we prioritizing enough?” held at the Executive Hall of the International Conference Centre, Abuja. She said that the components of combination prevention target the individual, groups/communities and society at large. She presented a matrix which looked at the relationships between the components of combination prevention and the groups mentioned.

According to her, combination prevention ensures evidence-based HIV prevention programming using data to “do the right things, do them right and at the right scale”; these are the three basic principles on which combination works. She decried the rate of incidence of HIV in the low risk population in Nigeria which is currently 42%, and the low rate of correct awareness about HIV which is about 27% as against the 85% for awareness in the general population. Addressing the underlying drivers of the epidemic would require a strategic and scientific prevention approach. She said that about 20 years available data exist for the biomedical aspects and lots of evidence-based strategies exist for behaviour change. The challenge however is the gap in available data globally for the structural aspects of prevention.

The gap between gender power play and unprotected sex; enormous average cost variation in service delivery; weak political commitment; and capacity challenges were critical issues highlighted as inimical to successful combination prevention. She speculated that increased spending and open political dialogue on sexuality and gender issues by the political class and a paradigm shift from Information, education and communication materials to behavioural change and social mobilization programmes could have long term advantages.

The NACA Director General Professor John Idoko spoke extensively on mobilizing resources for quality prevention and corroborated the first speaker’s presentation. He emphasized the importance of looking inwards for resource generation as regards to finances, capacity, infrastructure and manpower. He said it is important for government structures at the centre, states and local governments to demonstrate ownership. He spoke about the huge window of opportunity for resource generation that exists in the private sector in Nigeria and the importance of utilizing Faith based organisations. According to him, HIV is a developmental issue and Nigeria has to relate it to all the other MDGs to ensure attainment of set targets. He said Nigeria must improve the infrastructure of all Primary Health Centres (PHCs)in the country if quality integrated HIV/SRH/FP/TB services are to be provided at the community level.

Dr. Kalada Green, Senior HIV Prevention Advisor UNAIDS Nigeria introduced the Minimum Prevention Package Intervention (MPPI). He said this concept ensures prevention programmes are carried out in a sustainable way at an effective dosage and intensity. The MPPI designs programmes which consider the individual, community/environment, socio-cultural/socio-economic factors. MPPI programmes are measured using the Prevention Intervention Tracking Tool (PITT) and can be applied in community outreach interventions, Most at Risk Population (MARPS) awareness, peer education interventions, workplace interventions, infection control measures, and media interventions. According to him, in the near future, the MPPI has the potential to tell us the approximate amount of finance that would be enough to deliver a minimum prevention intervention package for a specific population and the expected outcomes.   

The special session was chaired by the Chairman of the House of Representative House Committee on AIDS, Tuberculosis, Malaria and Leprosy, Honourable Oluwole Olakunde. He mentioned in his opening comments that government was committed to improving the health infrastructure in the country and informed the gathering that the Anti-stigmatization bill would be passed in a couple of months.