Health experts say government must do more to stop the trend.
By Tobore Ovuorie
Nigeria has the highest number of children contracting the Human Immunodeficiency Virus, HIV, in the world, the latest report by the United Nations has shown.
The report says nearly 60,000 Nigerian children were infected with the virus in 2012, a figure higher than that of any other country in the world, and is a source of worry for experts with one describing it as “alarming.”
The report titled “2013 PROGRESS REPORT ON THE GLOBAL PLAN: towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive” is the most recent on the global plan which seeks an elimination of new HIV infections among children by 2015, as well as keep their mothers alive. The programme was launched in July 2011 at the UN General Assembly High-Level Meeting on AIDS (acquired immune deficiency syndrome).
Also, despite the efforts of the federal and state governments to check the spread of HIV, the report shows that the prevalence rate of HIV among Nigerian children has remained relatively stagnant with no significant improvement; while that of several other countries was improving with fewer prevalence rates than before.
“In several countries, the pace of decline in the numbers of children newly infected has been slow and the numbers have actually risen in Angola. Nigeria has the largest number of children acquiring HIV infection- nearly 60, 000 in 2012, a number that has remained largely unchanged since 2009,” the report stated.
Nigeria affects the world
The UN said it is worried about the prevalence rate of HIV among Nigerian children.
The global body warned that if Nigeria doesn’t sit up in curbing HIV in children, the global target, part of the Millennium Development Goals, MDGs, will not be realised by 2015.
“Without urgent action in Nigeria, the global target for 2015 is unlikely to be reached,” the report stated.
Also, while Nigeria witnessed stagnancy, since 2009, in the prevalence of HIV among children, several other Sub Saharan African countries, witnessed a massive reduction in the prevalence rate of the condition.
Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa, and Zambia all witnessed a 50 per cent decline in new HIV infections in children, while two more countries- the United Republic of Tanzania and Zimbabwe- are very close to achieving this target; prompting the UN to warn Nigeria to sit up in the fight against HIV in children.
Nigeria’s comparatively poor performance in combating HIV transmission to children also reflected among the 21 countries under the Global Plan watch of the UN.
“Nigeria accounts for one third of all new HIV infections among children in the 21 priority countries in sub-Saharan Africa: the largest number of any country. Progress here is therefore critical to eliminating new HIV infections among children globally.
“Nearly all indicators assessed show stagnation and suggest that Nigeria is facing significant hurdles,” the report stated.
The report stated that “the 21 countries (those under the Global Plan watch) had 210,000 newly infected children in 2012. This represents a reduction of 130,000 new infections annually or a 38 percent drop from 2009 when these countries had 340,000 new HIV infections among children”.
It was however, not all sad tales, as the report commended some of the efforts of the government in checking the spread of HIV.
“However, the government has already taken a bold step to focus on the 12+1 states with the highest burden of HIV, which account for about 70% of new HIV infections.
“In addition, it is rapidly scaling up service delivery to stop new HIV infections among children and has embarked on an intensive state-focused data-driven decentralization initiative,” the report stated.
Experts identify problems, proffer solution
This latest report by the UN is already a source of concern for experts in the health sector.
The Executive Director, Centre For Women’s Health And Adolescents’ Development, Port Harcourt, Rivers State, Helen Odega, described the report as alarming.
“it is an alarming report which means more effort has to be put in place to curb this embarrassing menace,” she said in an interview with PREMIUM TIMES.
“I still find it hard to believe since we have and are still pumping much into campaigns against this socio-economic and demographic cankerworm ravaging our tomorrow leaders.”
Ms. Odega, however, admitted that the authorities in the health sector have been lagging in the implementation of the prevention of mother to child transmission of HIV, PMTCT, policy.
“Sincerely speaking, I think (PMTCT) implementation is really zero and the country is not taking responsibility and ownership. We have policies which are not being implemented and the problem lies with the government which ought to channel the resources and claim ownership and do the right thing. A lot of work indeed needs to be done in PMTCT,” she said.
She advocated for PMTCT awareness campaigns saying a lot of women are ignorant about HIV.
“Emphasis should be placed on women attending antenatal sessions and give birth there and not go to faith based organisations,” she said.
According to Ms. Odega, the faith based organisations or traditional birth attendants, TBAs, make women living with HIV give birth through the vagina since they are unaware of the women’s history. This, she said, causes the mother to infect her baby.
“Healthcare providers should ensure that pregnant women return to the hospital to give birth and not just attend antenatal sessions in hospitals alone,” she added.
For the head of the Nigerian doctors’ union, more efforts need to be put in by the government.
Osahon Enabulele, the President of the Nigerian Medical Association, NMA, said there is a huge gap in the prevention of mother to child transmission of HIV, PMTCT, and added that more strategic policies in the area of PMTCT need to be implemented.
According to Mr. Enabulele, access to antiretroviral drugs and awareness about the virus has helped reduce the prevalence of HIV in Nigeria, but the country is still off-track in combating mother to child transmission (MTCT) of HIV.
“There’s no doubt that efforts have been made by NACA, (National Agency for the Control of AIDs) but we also recognise that the gap in PMTCT is huge. More strategic policies that will boost PMTCT needs to be done,” he said.
PMTCT is an intervention that aims at reducing to less than two percent the risk of Mother to Child Transmission of HIV through the use of anti-retroviral (ARVs) as either prophylaxis or therapy given to women in pregnancy, labour and during breastfeeding. In situations where a mother is not receiving ARVs during the breastfeeding period, the breastfed infant is placed on ARV prophylaxis until one week after cessation of all breastfeeding. Where breastfeeding is not possible, the use of commercial infant formula is usually advised as alternative.
Mr. Enabulele said there is a need for Nigeria to place priority on the mother to child transmission of HIV.
“More focus on PMTCT strategy needs to be put in place and ensure mothers have more awareness to go for test and commence treatment on time if HIV positive. Breastfeeding practices still need to be addressed while drugs should be made available to mothers as well as pregnant women who are HIV positive.
“Education, enlightenment and access to drugs especially women in rural areas must be upgraded as many of them still believe that HIV is a myth,” he added.
Government official disputes report
In what now appears a general characteristic with Nigerian public officials to dispute global statistics not favourable to the government, a health ministry official said Nigeria may have official figures different from that of the UN.
The Deputy Director, Department of Family Health, Federal Ministry of Health, Chris Isokpunwu, told PREMIUM TIMES that he is sure that the Nigeria agency with the responsibility of curbing HIV/ AIDS, NACA, has figures that debunk the UN’s claim.
“I’m very sure NACA will have a different figure on that and I don’t think the global target will be missed because of Nigeria,” he said.
Mr. Isokpunwu, however, said Nigeria’s seemingly poor performance was caused by both political and economic factors.
“The political aspect has to do with the leadership though I still very much believe that Nigeria is making progress,” he said.
Records from the Federal Ministry of Health show that in 2011, only 15.89 percent of HIV positive pregnant women received ARVs to reduce the risk of MTCT (mother to child transmission) just as only 2.3 percent of infants born to HIV infected women (HIV exposed infants) received ARV prophylaxis to reduce the risk of early MTCT in Nigeria.
Globally, HIV is a leading cause of death in women of reproductive age and since nearly all HIV infections in children are acquired from their mothers, the global epidemiology of HIV in children reflects that of HIV in women.
Over 90 per cent of infections in children are acquired through MTCT.
MTCT is the term used for vertical transmission of HIV from an infected mother to her newborn.
With over 60 per cent of adults living with HIV being women, the number of infected children has been growing. This, experts say occur during pregnancy, labour and delivery or during breast-feeding. In the absence of interventions, the risk of such transmission is worse- 45perecnt.
A member on the National Task Team on PMTCT, Emmanuel Enabulele, revealed that MTCT is fast becoming a burden in Nigeria compared to the rest of the world due to higher prevalence of HIV in women of reproductive age, high total fertility rate, characteristically prolonged breastfeeding culture, stigmatization by healthcare givers, and poor access to PMTCT interventions as a result of the Federal Government not living up to its promises among others.
The federal government had, in 2010, committed to reducing by at least 50 percent HIV incidents among 15-49 year old women by 2015. The FG had also promised to ensure that at least 90 percent of all pregnant women have access to quality HIV counselling and testing by 2015.
That year, it also said that by 2015, at least 90 percent of all HIV positive women and breast feeding infant-mother pairs would receive antiretroviral (ARV) prophylaxis, while at least 90 percent of all HIV exposed infants would have access to early infant diagnosis services and at least another 90 percent of pregnant women requiring antiretroviral therapy (ART) for their own health, would receive life-long ART.
Unfortunately, two years to the expiration of the deadline, Nigeria is still far away from achieving the set goals, while reports such as the latest UN scorecard means more needs to be done.
Mr. Enabulele reiterated the need for the Nigerian government at all levels to increase funding and strengthen capacity building, improving co-ordination and integral Maternal, Newborn and Child Health (MNCH) programmes.