LARA ADEJORO writes about tales of secrecy, betrayals, and ignorance, as parents infect newborns with HIV
Fiddaus and five other women were trying their hardest to steel themselves against the jab that memories of betrayal were about to give them.
But she eventually broke down among others inside the office of Halliru Memorial Youth Development and Empowerment Initiative in Kano State.
Over a decade ago, her husband infected her with HIV and kept it a secret until after she had her third child, about the time his own immunity succumbed to the attacking viruses.
Yet, he refused to tell her. Her in-laws, who took him to the hospital, ensured she remained in the dark, not even minding the health of the newborn.
“I suspected something was wrong, so I went to the hospital to run some tests, and I tested positive for HIV,” she told The PUNCH.
In tears, she explained how she refused to accept the result, but on the advice of the doctor, she headed to another facility for another test in her Gwale Local Government Area of the state.
She wiped her tears now flowing with her multicoloured hijab. “It was true. They said I have HIV,” she said
Tests carried out on her children also showed that she infected her third child with the virus that attacks the body’s immune system.
After her husband’s death six years ago, her brother-in-law told her they kept his HIV status a secret so she would not miscarry her baby. To her, that was medicine after death.
Alone now, she is left with nothing except her petty trading, and she has to pick up all the responsibilities – feeding, medicals, rent, school fees, and others.
She has also decided to keep it secret from her infected son, Ibrahim, but she takes caution—like keeping sharp objects where no one can see them.
“The third child knows something is wrong since he takes medication daily, but he doesn’t know what exactly. I encourage him to take his medication regularly and avoid rough play at school or anywhere, but no one else knows his status including himself. When he is grown, I will find a way of telling him,” she said.
Fiddaus’ ordeal is common in her home state Kano, where the proposed compulsory HIV testing bill for intending couples did not see the light of day.
Out of the projected population of 15.46 million, the northwestern state bears 0.5 per cent burden of the HIV prevalence rate in the country. That is quite a great deal for a state with a low literacy rate.
Our correspondent who spoke with six mothers taking care of children living with HIV—some as old as 50, asked to be identified only by their first names, for fear of stigmatisation.
They shared in Hausa stories of ignorance, poverty, and how cultural expectations of masculinity contribute to the risks of HIV infection.
Setbacks
Mother-to-child transmission of HIV is the spread of HIV from an HIV-infected woman to her child during pregnancy, childbirth, or breastfeeding, according to the National Agency for the Control of AIDS.
Mothers infected with the virus can transmit the virus to their babies in utero, intrapartum, or postpartum through breastfeeding.
This form of transmission is the most common way that children become infected with HIV, the agency that coordinates HIV activities in the country added.
Ideally, a pregnant woman with HIV should receive HIV medicines during pregnancy and childbirth to reduce the risk. Or a woman with HIV may have a scheduled cesarean delivery to prevent transmission during delivery, but the uptake of antenatal care and facility delivery is poor in Nigeria.
Only 57 per cent of pregnant women in Nigeria had four or more antenatal care visits, according to the 2021 National Bureau of Statistics report.
The President of the Society of Gynaecology and Obstetrics of Nigeria, Dr Habib Sadauki, said only about 50 per cent of Nigerian women utilise healthcare facilities during delivery.
The national data on the use of health facilities by women is a reflection of one of the factors contributing to the spread of the infection among children.
Babies born to women with HIV are meant to receive HIV medicine for six weeks after birth to reduce the risk of infection from any virus that may have entered a baby’s body during childbirth, but the country’s early infant diagnosis coverage is still very low.
Disease burden
Despite efforts by the government and stakeholders on the prevention of mother-to-child transmission of HIV, there are many children less than 15 years living with HIV.
In Nigeria, children aged 0 to 14 living with HIV are estimated to be 170,000, according to the 2021 factsheet by the Joint United Nations Programme on HIV/AIDS.
The report also showed that about 26,000 children aged 0 to 14 were newly infected with HIV, the number of deaths due to AIDS in the age under review is 17,000, and no fewer than 1,200,000 children aged 0 to 17 were orphaned due to AIDS.
UNAIDS said the percentage of children aged 0 to 14 receiving antiretroviral therapy is at 31 per cent, revealing a treatment gap.
“The number of children aged 0 to 14 receiving ART is 54,410,” it noted.
Early infant diagnosis is estimated to be at 15 per cent.
The World Health Organisation Country Representative, Dr. Walter Mulombo, said, Nigeria bears the highest burdens of tuberculosis and paediatric HIV, while accounting for 50 per cent of neglected tropical diseases in Africa.
Mulombo said this at the sixth annual conference of the Association of Nigerian Health Journalists themed ‘Health Security, Universal Health Coverage, and National Health Insurance Act: How can Nigeria get it right – The role of the media in perspective,’ in Lafia.
The National Coordinator of the AIDS, Sexually Transmitted Infections Control and Hepatitis Programme, Federal Ministry of Health, Dr Akudo Ikpeazu, who represented the Minister of Health, Dr Osagie Ehanire, during the 2022 World AIDS Day press briefing, said there is a need to equalise access to essential services, particularly for children, pregnant women, key population, and their partners.
“To do this, we must, in a consistent manner, address and remove all structural barriers that impact negatively on access to services.
“Some of the specific strides we have made this year in addressing these issues around access include prevention of mother-to-child transmission mapping to identify all places where pregnant women get delivery services to find the HIV-positive pregnant women.
“Based on the findings, we are working towards expanding the point of service from the current 6,000 to about 40,000 locations across the 36 states and the FCT. Our aim is to find all pregnant women and test all of them to ensure that all who are positive are placed on treatment and ensure that we can report on every mother who has been tested and placed on treatment.”
‘Nothing prepared me for this journey’
It took a referral from the Muritala Mohammed Specialist Hospital, Kano, to Aminu Kano Teaching Hospital, Kano, for Binta to know her HIV status when she fell ill.
Unfortunately, she had infected two out of her four children.
“Nothing prepared me for this journey, honestly. I don’t know how I got infected. My husband is infected too.
“As far as I’m concerned, no drugs were administered to me when I was pregnant or at delivery when I had my first baby at the hospital.
“For the second HIV-positive child, I didn’t even know I was pregnant. It took a while before I knew, and then I gave birth at home. My other children are negative. Though I learnt how to take precautionary measures now, I learnt late,” the 30-year-old woman said.
She used to sell groundnut but currently has no capital to continue the business.
She said her infected husband travels to other states to look for how to fend for the family—indicating how the search for livelihood exposes them to risks of HIV infection.
A search for livelihood factor
The Executive Director of AYDI, Aisha Halliru, explains how ignorance, seasonal migration, illiteracy, and polygamy work together to spread the virus further.
Her organisation works with over 400 caregivers in eight LGAs in Kano where all these are rampant among women.
According to Halliru, some men, especially in rural areas, leave their homes for another state to work during the dry season, and from there, they have unprotected sex with other partners that may be infected with HIV.
“Meanwhile, at home, they have two or three wives and by the time they come back, all the three wives are infected,” she said.
The increase in awareness is helping to reduce stigmatisation around HIV, but she said, “Basically what is driving it is interstate travelling, ignorance, and female sex workers.
“Some of them know they are positive and transmit the virus to others.”
Caught unawares
Twenty-eight-year-old Amina had her whole life ahead of her but was left utterly downcast when she learnt of her HIV status.
The mother of two from Gezawa Local Government Area, Kano, does not know when and how she got infected.
“The only thing I know is that three years ago, I became constantly sick, and then I went to the hospital. After running the necessary medical checks, they found nothing wrong with me. On second thought, the doctor asked that I run an HIV test since I was emaciating and the test turned positive,” she narrated looking deep in her thoughts.
She ran the test again.
This time, exercising her faith, but she was confirmed positive.
Amina’s family of 14—her husband, three other wives, and nine children—went for the test and the results showed that her husband and two wives were infected.
The third child, who is Amina’s first child, Adama, now 11, tested positive too.
None of them knew how they were infected.
“I went for antenatal when I was pregnant but I am not sure if I was tested for HIV. But, when I gave birth to her, she was sick, the stomach was swollen and they found nothing wrong, they assumed the baby had a kidney problem,” she said.
Now her daughter only knows she is sick, but doesn’t know what exactly she takes medications for.
“I will tell her later. I will find a way to tell her gradually but not immediately. I don’t allow the children to share razor blades or any sharp objects. If they use razor blades, I dispose of them immediately,” she said.
Experts say the barriers to access to HIV prevention, care, and treatment services make the goal of ending the epidemic by 2030 in Nigeria out of reach despite some remarkable progress made in addressing the epidemic there.
Way forward
Elimination of MTCT of HIV is strongly supported by global commitments and the promotion of integration of prevention of MTCT interventions into maternal, newborn, child, and adolescent health services, as well as strengthened health systems, the WHO said.
“In addition, improved access to sexual and reproductive health services – including preventing unintended pregnancies and screening and treatment for sexually transmitted infections in women and girls living with HIV – is being actively promoted.
“The integration of interventions has led to the Triple Elimination Initiative, which not only promotes person-centred care but also reduces incidence, morbidity, and mortality. The initiative also strengthens disease monitoring through the use of strategic information for response planning,” the global health body noted.
The Coordinator of the Association of Women Living with HIV and AIDS in Nigeria, Assumpta Reginald, said all the evidence for improving maternal uptake of facility services points to the need to invest in community structures and systems.
She said PMTCT will require active community engagement to make the needed difference.
“We as community members have a huge concern about the poor will to invest in community systems to drive what concerns us. Investments in community systems to drive PMTCT is poor, inconsistent, and done with tokenism. It is a bridge of our rights to care to know about best practices and not institute this,” she said.
The Programme Director, the Global Fund-supported National Aligned HIV/AIDS Initiative, Christy Laniyan, said there is a need for every woman to know their HIV status.
“We must ensure that every woman, who becomes pregnant, tests for HIV to know their result just like they will test their packed cell volume to know whether they are anaemic. If a woman is pregnant and anaemic, she may die, and she may give birth to a low-birth-weight baby but once they know she is anaemic, there are things she will be given that can increase her blood level, make the baby be born healthy, so is the same with a pregnant woman who is HIV positive.
“When she knows her status, there are enough technology and tools in hospitals to help her deliver an HIV-negative baby. It will be good to have a generation of children in Nigeria who are not HIV positive to achieve the elimination of mother-to-child transmission,” she said.
A professor of Medicine and Consultant Pulmonologist, Ademola Fawibe, said HIV treatment is free but major obstacles to accessing the treatment are stigmatisation and poorly coordinated health care services leading to poor coverage of people in remote areas.
Fawibe said barriers to access to HIV prevention, care, and treatment services are a threat to eliminating the disease by 2030.
He explained that stigmatisation often comes from a lack of understanding and inaccurate or misleading media representations of the illness are the main reasons for the misunderstandings and fears.
He said people should seek accurate information about the disease before disseminating it.
“For the population in the areas where it is difficult to access healthcare services, the government should ensure that these people have easy access to good healthcare coverage including HIV care.
“I encourage people to abstain from indiscriminate sex and get tested before marriage. I advise married couples to be faithful. For those who cannot abstain before marriage or those unable to stay faithful to their partners, the best is the consistent use of condoms.”
For children less than 15 years living with HIV, especially those in schools, he called for the need to educate them to avoid sharing sharp objects.
He also warned against other risky practices such as substance abuse, and group sex, which can enhance transmission to others.
There is currently no effective cure but with proper medical care, HIV can be controlled.
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