By Abiose Adelaja Adams

Selina (not real name), 28, was wiping away her tears with the edge of her wrapper when this reporter met her. It was as though the frail cry of her eight weeks old baby had pulled the string of tears from its glands all the more.

Her baby, swaddled in the same brown and red-patterned Ankara she wore, had just been tested for HIV at the Massey Street Children’s hospital, a major referral paediatric HIV center in
Nigeria. The result came out positive, shattering her world like a death sentence.

Between her and the wall she faced, she quietly massaged the baby’s right vein from which blood had just been collected, totally oblivious of the commotion being caused by scores of women and children in the crowded reception area.

She was too broken hearted to notice the world around her, seemingly withdrawing into her suddenly shattered universe.

Meanwhile, the medical director of the hospital, Abieyuwa Emopkae, told www.icirnigeria.org that HIV cases in children is on the rise in the hospital, which is renowned as the first out-patient General hospital in Nigeria. ( since 1914).

“There was a time we were seeing less and less of the cases. But in recent times, we have been seeing more of such cases,” said Emopkae who is very experienced in these matters as he is also a member of National Steering Committee on HIV/AIDS,

Twenty six years since the first case of HIV/AIDS in Nigeria, the disease has become one of the leading causes of child mortality after premature birth, thus robbing the country of the child survival gains and defying four out of the eight millennium development goals.

Why the spike?

“We are wondering…Is it that new immigrants are coming to Lagos or mothers are no longer accessing care, or that more they are not being tested? These are some of the challenges we are looking at.”

A recent report by the World Health Organization, WHO, shows that Sub-Saharan Africa is the most affected region, with 24.7 million people living with HIV in 2013.

Africa accounts for almost 70 percent of new global HIV infections and most of these infection are in children. Already 3.2 million children were living with HIV at the end of 2013 and most were infected by their mother during pregnancy, birth or breastfeeding.

Emopkae explains that prevention of mother to child transmission, PMTCT, begins at the point of identifying mothers during antenatal clinics, integrating them into comprehensive care such as administration of antiretroviral drugs (ART), monitoring their viral load, nutrition and follow-up care.

“There is something going on that we need to track. For instance, in Lagos here there are more antenatal centers and so you see the graph of women attending antenatal care is high, but when it comes to taking ART, not so many are on treatment.”

He maintained that the drugs and services are available, but women are not taking them up due to cultural attitudes and poor health seeking behavior.

“Of course we know that there are issues of stigma, delay in obtaining results – some say come back in a week’s time etc. There is also denial – people not believing that it is true, because they are not sick yet. It is a major issue,” he explained further.

If a woman like Selina had been identified as HIV positive and had taken up the care, she would not have infected her unborn child and that is the simple meaning of PMTCT. The national programme for PMTCT of HIV started in 2001 with actual services delivery taking off in six tertiary institutions in 2002.

Since then the programme has been expanded to the primary and secondary health facilities in order to bring the services closer to the communities.

Despite this, many women are still not reached. A case in point is Ogun State, where a senior nursing officer, Omolara Akinpelu, heading the primary health center of Ijebu East local government, said lack of access to treatment as well as cultural attitudes, are a major barrier

“For instance in this hospital, we have about 6-10 bookings in a month, but we may take only one delivery. During the booking we discover a lot of HIV positive women, but we don’t have the treatment here so we refer them to the nearest place, Ijebu-Ife, which is about an hour’s drive away.

“And you know since this is a rural setting we have a lot of trouble to convince them to come to clinic, not to talk of sending them to as far as Ijebu-Ife for treatment. So on the day of delivery, most of them go to traditional birth attendants, and so the HIV spreads a lot here.”

WHO says that if PMTCT services are effective transmission can be reduced to as low as 2 percent. According to the figure released by the National Agency for the Control of AIDS, NACA, on this year’s World AIDS Day, 54 per cent of HIV pregnant women in low- and middle-income countries did not receive an HIV test in 2013.

Meanwhile, the executive director of Journalists Against AIDS, Layide Akanni, agrees with Emopkae that the services are available, but women are not taking them up.

“In the south, many women attend traditional birth homes and faith based attendants, uptake of antenatal services is low. Thus, many women are being systematically missed out,” he noted.

Akanni remarks that only about 19.7 per cent of HIV positive women are accessing antiretroviral treatment which will help reduce the risk of transmission from mother to child.

Implication
Emokpae says the implication is grave. “If we don’t do anything about this, all the gains of child survival strategy will be lost.”

In bridging the gap in HIV treatment and prevention, Nigeria recently launched a National Operational Plan for the 2015-2016 period targeted at the elimination of mother to child transmission of HIV in Nigeria.

Speaking at the launch, John Idoko, the director general of NACA explained that eliminating mother to child transmission of HIV has ripple effects on the Millennium Development
Goals, MDGs 3, 4, 5 and 6.

Another consequence of Mother to child transmission is breeding a new generation of adolescent who have been HIV positive from birth who do not really know their status.

Experience shows that the parents who infected them are either dead or are unwillingly to disclose their status to them for fear of stigma.

Speaking about the Massey Street Children Hospital’s experience, Emokpae stated : “They are faring badly, they are beginning to ask questions, why am I taking these drugs..”

“The implication is that they are not taking their drugs, because they are not told why they should keep taking drugs, therefore they pretend to put it in their mouth but they are not swallowing it.”

He said further that, thus, such children are now resistant to the drugs and coming down sick again.

‘I know one who has been here three times sick, because he wouldn’t take his medications and their parents are not telling them. It is a major problem.”

He figured that culturally, it is not easy for a mother to tell her child that he has HIV and he got it from her because “everybody thinks of HIV that it is an immoral thing.”

The NACA report shows also that 60 per cent of all new HIV infections among young people aged 15–24 occurred among adolescent girls and young women.

“These group of children, 10-24, are going through a lot, and nobody cares about them: Remember they will soon become sexually active.”

There were approximately 35 million people living with HIV at the end of 2013 with 2.1 million people becoming newly infected with HIV in 2013 globally.