By Franca Ofili, NANSelf-stigma has been identified as one of the major issues responsible for the low uptake of HIV/AIDS and Prevention of Mother to Child Transmission (PMTCT) services in Nigeria.
Over time, persons especially women that tested positive to HIV/AIDS have consistently lived in self-denial orchestrated by stigma and other factors beyond their control but caused by the society.
Mrs Anthonia Nzeli, a 35 years old banker, was diagnosed to be Human Immunodeficiency Virus (HIV) positive during her first pregnancy and was placed on antiretroviral drugs.
Being a young lady, Nzeli could not imagine how she could cope with taking the drugs for the rest of her life and she subsequently stopped taking the medication.
She said her decision was based on the advice of her pastor who discouraged her and asked her to pray as God would solve every problem.
According to her, she was using the local herbs believing it will solve her problem.
Nzeli said after she gave birth, the baby became sick on his three months and was taken to the hospital only to be diagnosed as HIV positive.
“That day, I felt as if the world has come to an end until a nurse came to my rescue, educated me on the necessary things to do to live a better life with the virus.”
According to her, the nurse arranged an appointment for her with a doctor and was advised on how to live with her baby.
“The doctor advised me to come with my husband to carryout test on him but he refused to come.
“Since then, I have been on PMTCT treatment and my baby is also on drugs and was asked to come for test with my child in order to monitor us.
She said that lack of proper information on HIV has affected many families and urged the government to ensure that people are properly educated on the virus and how to manage it.
Nzeli said with the proper information gotten, she enrolled in PMTCT treatment to be able to have her second child HIV negative.
She said after five months the husband agreed to have the test and was positive, adding that the family has been on drug since ten.
“I believe with proper information on PMTCT many pregnant women would have HIV negative babies.”
In spite of having been tested for HIV during pregnancy, most women have limited knowledge and awareness of the virus and of PMTCT in particular.
There are several potential barriers to the provision of PMTCT including: HIV testing without adequate informed consent and counselling.
Others are gaps in HIV and Mother-to-Child Transmission of HIV (MTCT) knowledge among women, perceived stigma at the household and community level with HIV-related cultural beliefs.
Among women who had been tested for HIV, awareness and knowledge of HIV and PMTCT remained low.
There would be need for mobile phone communication for improving uptake of antiretroviral therapy in HIV-infected pregnant women.
Socio-cultural and operational challenges, including HIV testing without informed consent, present significant barriers to the scale-up of PMTCT services for women in the country.
Also strengthening local capacity for effective counselling and testing in the antenatal setting is paramount.
HIV is a principal contributor to the high burden of maternal and infant mortality and morbidity in the country.
Some medical experts have given solution on what the country can do to address the issue of low PMTCT in the country.
Dr Ijaodola Olugbenga, Deputy Director, PMTCT, Lead for the National Prevention of Mother-To- Child Transmission of HIV and AIDS (PMTCT) had advocated for state governments to procure HIV commodities to boost PMTCT services.
According to Olugbenga, there was an urgent need for a clear community strategy to reach the unreached, as well as to mobilise community influencers, especially religious leaders, who would help to educate pregnant women on PMTCT need.
He said that there was need to understand why about 60 per cent of pregnant women delivered at home and then respond to their needs with a clear strategy.
Olugbenga also called on the Federal Government to declare a national emergency on PMTCT.
He said there was an urgent need for a clear community strategy to reach the excluded, recognize the importance of working with all actors, private providers, traditional birth attendants (TBAs), community leaders and networks of people living with HIV.
Olugbenga called for the creation and empowerment of the Local Government Zone (LGA) team to process HIV-related data, sample registration, commodities and other services.
He said there was a need to organize all facilities (public and private) and other service delivery points for HIV services for pregnant women using a “Hub and Spoke” model.
The hub and spoke model refers to a distribution method in which a centralised “hub” exists. Everything either originates in the hub or is sent to the hub for distribution to consumers.
From the hub, goods travel outward to smaller locations owned by the company, called spokes, for further processing and distribution.
“We need to strengthen the communication and use of data based on the hub and spoke approach and with the commitment of the LGA team.
“There is a need to develop a realistic state-specific approach to improve the development of Ante Natal Clinic (ANC), ANC testing and PMTCT coverage.
“Approval and implementation of the state-level framework for the elimination of mother-to-child transmission of HIV and syphilis,” said Olugbenga.
He decried the low uptake of antenatal care services, low uptake of early infant diagnosis services, and urged women to know their HIV status before they get pregnant to help them plan accordingly.
Mr Geoffrey Njoku, UN Children’s Fund (UNICEF) Communications Specialist in Nigeria, also urged the media to focus more on the reportage of PMTCT of HIV and AIDS to ensure a society free of HIV children.
Njoku said that the media needed to provide an update on the current status of HIV and AIDS in the country, added that the media needed to bring back HIV and AIDS to the front burner by educating pregnant women on the importance of PMTCT.
Dr Atana Ewa, Associate Professor of Paediatric Respiratory/Infectious Disease, University of Calabar Teaching Hospital, said that the management of children living with HIV needed more focus attention and enlightenment.
Ewa stressed the need for increased screening among women of child bearing age and pregnant women to check the spread of the virus.
She said: “We need to ensure reduction of prenatal transmission, give antiretroviral drugs to pregnant women and during breastfeeding.”
She noted that for treatment modalities, acute bacterial infections must be addressed with the treatment of opportunistic infections.
She advised all pregnant women to go for counselling and be tested for HIV during antenatal, adding that HIV and AIDS remains a major cause of infant and childhood mortality and morbidity in Africa.
“Ideally, the healthcare provider should counsel the parents and look for HIV in a child presented to a health facility Provider Initiated Testing and Counselling (PITC), as identifying HIV in children requires a high index of suspicion.
“Usually, the symptoms and signs of HIV infection in childhood are similar to those of other diseases seen in the tropics; but they may be more severe and occur more frequently.
“The common conditions associated with HIV are frequently infectious in nature,’’ she said.
Ewa said that early features usually non-specific are fever, diarrhoea, failure to thrive, cough and generalised lymphadenopathy.
Others, she said were later the child would present with features indicative of severe immune suppression, signs of opportunistic infections and recurrent and more severe forms of common illnesses.
She advised that every pregnant woman should be tested for HIV to have proper data and start PMTCT.
“We need to ensure reduction of prenatal transmission, give antiretroviral drugs to pregnant women and during breastfeeding.”
According to World Health Organisation guidelines, all infants who test positive for HIV should be immediately initiated on treatment.
It said that the treatment should be linked to the mother’s course of ARV drugs and would vary according to the infant feeding method.
“Breastfeeding, the infant should receive once-daily nevirapine from birth for six weeks. While for replacement feeding, the infant should receive once-daily nevirapine (or twice-daily zidovudine) from birth for four to six weeks,’’ it said.
Mr Shola Ogundipe, Health Editor, Vanguard, said that the media needed to bring fresh perspectives into related HIV and AIDS issues in the country.
He said that the media would positively impact on the process of communicating government’s policy agenda and legislation on HIV and AIDS, with specific focus on PMTCT and EMTCT.
He said that over the years, Journalists Alliance for PMTCT in Nigeria (JAPIN) had pursued the PMTCT and EMTCT agenda in Nigeria.
He said this is in accordance with its role to ensure that mother-to-child transmission of HIV received the desired attention in relation to national HIV and AIDS issues.
“JAPIN has successfully utilised various media platforms and documented strategies to address the challenges of EMTCT of HIV by giving wider coverage of the issues in Nigeria.
“JAPIN has also bridged the communication gap between government, healthcare providers, mothers and civil society groups, as far as EMTCT in Nigeria is concerned,’’ he said.
Ogundipe added that JAPIN had provided improved knowledge on the scope and acceptability of infant feeding practices among women in Nigeria, specifically for HIV positive pregnant women.