Like in 2020, UNAIDS has again pronounced Nigeria as a country with the highest producer of HIV-positive children. Just how does such a negative situation persist despite the availability of free drugs, information and strategic interventions being put in place? Gboyega Alaka writes.
The revelation a couple of weeks back that Nigeria is the highest producer of HIV positive children globally by the Joint United Nations Programme on HIV\AIDS (UNAIDS), without doubt, called for concern. With the availability of information and efforts being put in place by governments and non-government organisations alike, many cannot understand why the country still occupy such an unenviable position in the comity of nations.
The UNAIDS noted that while the country has achieved a lot in placing over 1.6 million people living with the virus on treatment, more children are still left out of the lifesaving treatment.
The UNAIDS apparently based its submission on federal government data that says about 150,000 children are HIV positive, with only 88,000 on treatment. That, unfortunately, leaves a whopping 62,000 children without treatment and staring death in the face.
This, according to the Country Director, Dr Erasmus Morah, means the coverage for children is less than 50 per cent, and of course, robs off negatively on the achievement of 80 per cent coverage of adults and places Nigeria in that unenviable position. Morah also declared that “one in seven babies born globally with HIV is a Nigerian.”
Heavy as it sounded, the UNAIDS’ declaration did not come as ‘news’, only that it still shocked the sensibilities of well-meaning Nigerians. Early 2020, the then Minister of State for Health, Olorunimbe Mamora, had revealed that Nigeria has the highest number of paediatric HIV cases globally.
Bleak future for the kids
The implication of this revelation for kids still brought to the world with this dreaded disease is that they are condemned to a bleak and uncertain future. For no fault of theirs, they inherited the incurable virus from their mothers and are compelled to live with it, subject to all forms of discrimination and a life of endless regimented medication. But how do mothers still transmit this virus to their babies despite intensified government efforts at prevention of mother-to-child transmission (PMTCT)?
Kunle Badmus (not real name), 17, who lives with the virus, offers one possible explanation.
“I was told I got it from my mum’s breast milk; mum is late now by the way,” he said with a smirk.
If he escaped the virus during delivery, how then did he get it through his mum’s breast milk? To this Badmus simply slapped the back of his right hand in his left palm, which literally implied ‘I don’t know.’
His grandmother, whom he grew up with never gave him any more details; but he has borne the brunt of the disease, visiting hospitals to collect and down “awfully smelling drugs,” without which they told him, he’d literally wither like fallen leaves and die.
Earlier, when he attempted revolting against the drugs, he said his alarmed grandmother would scream and hang the threat of death over him like a hangman’s noose. When that stopped working, Badmus said she started showing him pictures of emaciated people who had come down with full blown AIDs and eventually died, literally screaming, “DO YOU WANT TO LOOK LIKE THIS?”.
“I think that got me,” the young man just out of secondary school, confessed.
Even though he had become despondent, even suicidal; he didn’t want to look like that before breathing his last.
While many young people who got the virus through their mothers did during delivery, many, like Badmus actually did through breastfeeding, defeating all the PMTCT effort of the government and health workers. A case in point would be that told by a doctor in one of the enlightenment sessions in Lagos years back, where a young HIV-positive mother who had managed to bring forth her son without the virus, budged at the insistence of her in-laws who weren’t aware of her HIV-positive status and gave her wailing baby her breast to suckle.
“The baby was crying inconsolably and her in-laws who had come to do the traditional ‘omugwo’ pressured her to give the baby breast. Not even her excuse that the doctor said she could not breastfeed, stopped them. The illiterate in-laws stepped up the pressure, telling her ‘which doctor go say make you no give your pikin breast? I beg give baby boby joo.’ Perplexed and especially with her husband not physically present, she capitulated and gave the kid her breast.
“She regrets it till today and still weeps for her inability to resist,” the doctor said.
“Do not fall into that category,” he warned his listening audience.
Another, Philip (not real name), now 25, who eventually got to know the truth about his status at the age of 15, said “I didn’t even understand the concept but they told me I could die if I didn’t take the drugs. My parents simply told me I inherited it from them and that I would understand it better as I grew up. They however advised me strictly against sex and told me not to tell anyone as they would look down on me. They didn’t exactly use the word ‘discrimination’, but I understood them well.
“From then however, I started reading it up and asking doctors question whenever I had the opportunity.”
It took some other adolescents and youth personal efforts to discover the drugs they were taking were antiretroviral drugs and that they were HIV positive. This of course was because their parents, who passed it to them, found it difficult to tell them. But it sparked huge row between them and their parents and disillusionment on the part of the kids.
Professor Oliver Ezechi, Director of Research, Nigeria Institute of Medical Research shared such scenario with The Nation in a past interview: “I remember one SS3 girl who did a search on Google and found out that the drugs she was taking were for HIV treatment and had to confront her parents. Another one went to the clinic on one of their many visits and just asked one child why they were always coming to the clinic. The child plainly told her that they were there because they were HIV positive. Another one told a neighbour that her mum always took her to a clinic at NIMR, and the person told her that the people they treat there are HIV patients. Another child asked his mum why he’s always sick and on medication when his other siblings don’t feel the same way. The mother told him they are multivitamins and he asked why only him? Another only got to know when his parents were planning to relocate to Canada.”
Why the persistence?
According to the National Agency for the Control of AIDS (NACA), in Nigeria, only one third of pregnant women have access to services to prevent mother-to-child transmission of HIV (PMTCT) services. Among the many reasons is the fact these services are only available in about 25% of the approximately 25,000 antenatal clinics listed in the health facility registry maintained by the Federal Ministry of Health. Even at facilities that are listed as providing PMTCT services, the full range of HIV services they offer is uncertain, as are the linkages between PMTCT, adult ART and paediatric ART services.
This situation has contributed to poor PMTCT and paediatric HIV indices. By the end of 2020, the coverage of PMTCT was as low as 44%. According to NACA, Nigeria, therefore, globally contributes the highest percentages of HIV positive pregnant women who are not on treatment (24%), babies with new HIV infections (14%), and children who die from AIDS-related causes (12%).
A direct attempt by this reporter to unravel the direct causes of Nigeria’s unenviable position, reaching out to a General Hospital in the Mushin axis of Lagos State, and a further visit the Infection and Disease Control Unit of the Lagos State Ministry of Health, revealed some insights.
Although medical personnel and officers spoken to declined official interviews on account of their positions as civil servants who were unauthorised to speak with the media, they nevertheless expressed surprise at the news, especially as they claim the prevalence of mother-to-child is literally zero in the state.
A senior personnel at the Heart-to-Heart Department at a General Hospital in the Mushin axis of Lagos, where people living with HIV access treatment and counselling, said the scenario, as painted by UNAIDS does not in any way reflect or apply to that particular facility.
Said the doctor, “This year, we have not recorded any case of mother-to-child transmission and it’s already December. The records are there. The last time we had a case like that was two years ago; she came in via emergency and she was not on treatment. I think she came in third semester.”
He, however, did not entirely dismiss the revelation by UNAIDS, saying such data could only have stemmed from the communities. He said, “Our problem is not getting these patients registered here. Most patients don’t come to the hospital. They either deliver at home or go to a Traditional Birth Attendant (TBA). There is also the problem of poverty. Some people will say they won’t come to the hospital because of money. Even transport money, some of them would claim they don’t have. It is only when the child is sick that they come to the hospital and then we’d discover that the child is positive.
“Some people, due to religious beliefs, still do not accept their status, even with glaring tests results. There was a case of medical personnel who vehemently refused to accept her positive status and went on to reject the treatment. In the end, the baby died and even the woman later died from HIV complications.
“But for those who do not exhibit such hard-line posture, HIV transmission is no longer common. I have had both positive parents who have had three children who are negative. Both parents accepted their situation and submitted themselves religiously to the treatment. Once the virus is reduced and suppressed; once the viral load is less than 20 or is non-detected with the mother, the chances that the mother can transmit to the child is zero; even when she is delivered of the child naturally. These days, with the right treatment, CS is no longer a prerequisite for safe negative delivery. The reason for CS may be there, such as the size of the baby, but it would not be because the mother is HIV positive”.
Those who patronise local ‘malams’ to shave or cut their nails, sharing blades, he said, are another major purveyor of the virus..
To encourage access to the drugs and take out the risks of stigmatisation, he said the hospitals have even decentralised the distribution of the drugs by giving them out to pharmacists to give out free to patients.
Describing those who patronise religious houses and traditional birth attendants for delivery, Dr Ezechi again said, “Those places are houses of death. People say health services are expensive, but the same people buy uniformed clothes for events almost every week, buy cell phones and data. I think it has to do with priority. We have worked with TBAs in the past, and we have taken HIV testing to some of those places, even to churches. But the most important thing is female education.”
At the Infection and Disease Control Unit of the Lagos State Ministry of Health, a top officer who also declined an interview, told this reporter in unofficial capacity that the UNAIDS declaration may be true, but it is not systemic.
He said, “We don’t have that record but it is most likely so. I however do not think it is a systemic problem. I think it has to do with the kind of people that we are and the poor health-seeking attitude of our people.”
He said all the tiers of government are trying their best to curb the scourge of HIV, adding that Lagos State has put up very effective strategy and interventions, which has forced down the prevalence.
He said Lagos State in 2010/2012 had a prevalence of about 5.1, which dropped to 4.1 in 2014. With the National HIV/AIDS Indicator and Impact Survey 2018, he said the equivalence of HIV/AIDS in Lagos dropped to about 1.3.
Corroborating the assertion at Mushin hospital, the officer said, “Lagos State has even recorded zero transmission of mother-to-child in some communities in Mushin.”
