Indeed, there is much work to be done. The issue of HIV/AIDS is now very real in Nigeria, a country that will soon see the largest number of people infected with HIV of any country in Africa. "Yet although there are some efforts already taking place related to prevention of HIV", says Masi, "very little is being done in the way of care and support for people who already have HIV/AIDS, and treatment is largely inaccessible except for the most affluent." The project will seek to provide care and treatment for those living with HIV/AIDS, with a particular focus on commercial sex workers in the area - clearly one of the most vulnerable and excluded groups. Treatment offered will be for opportunistic infections, sexually transmitted diseases, and ultimately treatment with antiretroviral drugs. "We plan, ultimately, to introduce HAART - highly active antiretroviral therapy - which has had dramatic effects on reducing morbidity and mortality in people affected with HIV-AIDS in the developed world," adds Masi "drugs that have, until recently, remained inaccessible to those most affected by the disease in Africa."

Yet without even some of the basic services in place - free and effective treatment for sexually transmitted diseases and tuberculosis, and voluntary counselling and testing - coupled with the widespread stigmatisation for those suffering from the disease, the project is going to be a difficult and testing process. Access to even basic medical care for those in need is often unaffordable or unavailable. The local health centre in Ebute Metta sees frequent shortages of drug supplies. According to Richard Bedell, an MSF HIV/AIDS Advisor who visited the area in August this year, "The doctors have no standard protocols for management of sexually transmitted diseases, and have no training about prophylaxis or treatment of opportunistic infections associated with HIV/AIDS". In neighbouring Amukoko, the primary health centre is even worse, he adds. The building was falling apart, missing windows, and the pharmacy contained only a few tins of medications - many of which had expired. "Health services have essentially been reduced to antenatal care, immunisation, and a well baby centre, since there are no facilities to deal with anything else" says Bedell. "It is no exaggeration to say that I have seen better facilities in Afghanistan, albeit with NGO support".

"This is an challenging opportunity in terms of showing that care and support of people with HIV/AIDS can be done in such a resource-poor setting, among some of the most vulnerable members of society," says Masi. "And because the government is now showing a certain degree of commitment to procuring a supply of cheap generic antiretroviral drugs, now is most certainly the time to act".

HIV is an overwhelming humanitarian crisis in Nigeria that continues to grow exponentially with no means of control in sight. The potential health, economic, and social impact is beyond comprehension, and the issues clearly need to be addressed now. "Ultimately we will develop and demonstrate a model of 'best practice' for provision of medical care and support that could be replicated in other comparable complex settings", adds Cathy Huser, the Head of Mission for Nigeria. "Although offering antiretrovirals in such a setting will be fraught with difficulties, to not attempt to offer these and other essential services to those most in need is to neglect thousands of people already infected with HIV." MSF anticipate that significant learning will take place during the course of this project and that this learning will contribute to an improved access to all essential medical care for this vulnerable population.

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