Ending HIV: Reaching children left behind in prevention services

Access to the prevention of mother-to-child transmission (PMTCT) HIV services is one of the key ways of preventing HIV and ending AIDS, according to experts.

However, to date, some pregnant women experience hardships accessing PMTCT care or do not have access at all.

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This has led to more children being born with HIV in the country when some other countries are recording zero cases of transmission of the disease from mother to child.

Elizabeth James, a mother of four who lives with HIV, said pregnant women still face challenges accessing antenatal care.

She said this is because some rural communities do not have primary health care facilities where women can access prevention of mother to children transmission services while attending antenatal care.

She said many traditional birth attendants (TBAs) are also not trained to provide prevention services for pregnant women.

She said, “The TBAs only see them through the pregnancy period, do delivery without conducting an HIV test, and even for those that might have this knowledge, there may not be a facility close by to do HIV test.

“Then for the communities that have primary health care, the cost of registering for antenatal is very high now which most rural women, who do not work and always depend on their husbands for everything, cannot afford,” she said,

James said in the facility where she volunteers presently as a mentor-mother, women pay close to N6,000 for their first antenatal visit.

“Sometimes, if we don’t have test kits, they pay for the HIV test. Also, if the non-governmental organisations supporting us do not have test kits, the facility will definitely have to buy test kits outside,” she said.

She said ignorance is a contributing factor to women not attending PMTCT services, adding that availability of facilities is the major issue because most communities do not have PHCs; and women prefer patronizing TBAs even in some communities that have.

She said while health facilities in cities may be conducting HIV tests on pregnant women, stigma still affects access to services in those facilities.

She said patients are required to pay consultancy fees in some of the facilities.

She added that while her four children live free of HIV, many other children are not that lucky.

Gaps in PMTCT services

Faruna Benedette, Senior Programme Officer, Association of Women Living with HIV/AIDS in Nigeria (ASWHAN), said stigma and discrimination are still an issue in many communities today.

“There is stigma from health care workers, place of worship and family etc,” she said.

She said other challenges include gender-based violence (GBV), insecurity, user fees, use of TBAs and distance.

Others, she said, include:

“GBV: this can manifest in form of domestic, economic, psychological etc.

“User fees: Some facilities demand some form of payment from women for services.

“Traditional Birth Attendants (TBAs): in many communities, women still prefer the use of TBAs to facilities.

“Distance: some facilities are far from rural communities.

“Low coverage of PMTCT programme in the country.”

She added that data was another challenge as the country does not have a central data collection system.

“Non-availability or inadequate coverage of Early Infant Diagnosis (EID) is another one as most times samples taken from an infant in Taraba, for instance, will be transported to Bauchi for test and in some cases, the samples get lost and some women never get the result of the test,” she said.

It is estimated that Nigeria contributes the largest number of babies infected with HIV at birth.

According to the Director-General of the National Agency for the Control of AIDS (NACA), Dr Aliyu Gumel Gambo, 21,000 children were newly infected with HIV in 2020.

“About 13,000 die annually out of about 150,000 children living with HIV/AIDS in Nigeria,” he said.

Dr Erasmus Morah, UNAIDS Country Director in Nigeria, said in spite of the progress made in Nigeria’s HIV response, the country is failing children living with HIV, with a vertical transmission on the rise.

He said children are still being left behind, and their treatment coverage remains much lower compared with adults.

He said, “Only 45 per cent of children living with HIV know their status, 45 per cent of them receive antiretroviral therapy (ART), and among those, 31 per cent have a suppressed viral load. It is sad to note that prevention of mother-to-child-transmission has been less effective over the past five years.”

Dr Gambo Aliyu of NACA said the agency was working assiduously towards expanding access to PMTCT services.

He said parents should know that the unborn baby under their custody has the right to be protected from HIV and as such the mother must, as a matter of responsibility, ensure she has access to HIV testing services during pregnancy.

“If the mother is HIV positive, treatment should start in earnest immediately and delivery should be at a facility where caution would be taken to prevent mother to child transmission during delivery, immediately after delivery and during the breastfeeding period,” he said.

On what the agency is doing to improve access to PMTCT services in remote areas, he said access varies from state to state.

“There are states where 95 per cent of the services that are required for the PMTCT exist and people are comfortable going to facilities to access antenatal services.

He said as long as pregnant women show up at antenatal centres, 90 to 95 per cent of them can receive PMTCT services.

National Coordinator of the National AIDS, STI and Hepatitis Control Programme (NASCP) of the Federal Ministry of Health, Dr Akudo Ikpeazu, said as, at June 2021, 150,000 children are HIV positive with 88,000 of them on treatment

She said 40 per cent of women who are pregnant every year access PMCTCT services, adding that following a national dialogue on PMCTC in May, the health ministry contributed 4.2 million test kits to facilitate testing of pregnant women not just within health facilities but to reach women wherever they are and ensure they are tested and placed on treatment.

Way forward

The National Coordinator of the Network of People living with HIV/AIDS in Nigeria (NEPHWAN), Abdulkadir Ibrahim, said having 150,000 living with HIV is not good news when other countries are recording total elimination.

He said, “There is need for mentor fathers, in our programmes because men approve their wives going for antenatal and accessing PMTCT services.”

He said it is unacceptable for HIV positive mothers to pay user fees in hospitals and that government should procure HIV test kits and ensure that they are tested.

Faruna Benedette of ASWHAN also said government needs to scale up PMTCT services by removing user fees, especially for pregnant women.

She said male involvement in PMTCT is key, adding that bringing men into activities in their communities would help champion the mobilization and sensitization of fellow men on the need to support women of reproductive age for antenatal care services which is the entry point for PMTCT.

She said another way is to renovate and equip primary health care centres  in rural communities to deliver quality health care services.

She said it is also important to sensitize religious leaders and train TBAs to conduct HIV tests and refer women to facilities for care when reactive.

Elizabeth James, the mentor-mother advised women to be self-reliant “because if a woman is empowered economically, and education-wise, she can stand on her feet and do whatever she wants to do.

Most women patronizing TBAs do so because their husbands decide so because they don’t want male health workers to see their bodies or because they don’t want to spend much, but if the woman has her own finances ‘she can decide that it is her life… “I am the one carrying the pregnancy and I want my baby to be safe, she can also afford paying the bill wherever it is.”

The DG of NACA, Dr Aliyu, said the country’s goal of eliminating mother to child transmission is in sight.

“But if we don’t have the pregnant women or the couple making it a duty to access the services whether, at the facility or now at the community level, (because we realize that not everyone wants to come to hospital or clinics for antenatal services, or to deliver), it is a problem.

“We are devising strategies now to meet these categories of individuals that we don’t see at our conventional facility at their place of preference.

“If it is their house, community centre, worship centres or wherever they are comfortable with, we are ready to reach out and meet them there to make sure we test that pregnancy for HIV,” he said.