Connect with us

NEWS

Silent epidemic: Gombe’s endless battle with growing children HIV menace

Published

on

Spread the love

 

For quite some time now, Gombe has been grappling with a surge in Human Immunodeficiency Virus among children. In this report, CHIMA AZUBUIKE examines the root causes fuelling the spread of the epidemic and possible ways of addressing it.

 

Usman Zainab, a 32-year-old mother of four in Gombe State, has been living with HIV for the past 18 years with her husband, Hameed.

Of all their children, only the last son, two-year-old Muhammad was born HIV-positive.

Our correspondent met Zainab at one of the HIV treatment centres in Gombe, however, when a visit was paid to her home in Malam Inna, a densely populated community tucked far from the metropolis, it became clear that stigma and discrimination still hung heavily like a cloak on individuals diagnosed with the disease.

Her house, a contraption of mud and tarpaulin, was pointed to our correspondent from a distance by residents with dismissive gestures.

A feeble-looking Zainab explained that living with HIV has been challenging, especially given her family’s financial status.

Accessing treatment, she also disclosed, has been hard due to the distance and cost of transportation to the nearest treatment facility to restock on anti-retroviral drugs.

More disheartening to this woman is the outright rejection and stigma mete on her toddler.

“People don’t want to have anything to do with my son, let alone to carry him due to fear of contracting the virus,” she lamented.

Zainab blamed her son’s HIV-positive status on negligence and her refusal to register for antenatal care and wished she could have an opportunity to make amends.

“I married a man who is also positive and he has been supportive and caring but you know the economic situation now. Fending for all of us has not been easy. There are times I don’t have transportation to get to the facility to get my drugs and that of my son because I have to collect from two points.

“I took for granted the importance of antenatal care. While pregnant for my three other children, I took care of myself and was careful but for Muhammad, I didn’t attend the antenatal clinic.

When he became sick after he was born, I took him to the hospital where he tested positive for HIV,” she narrated, weeping and cradling her son, who appeared confused at her outburst.

Ordeals of Women with HIV-Positive Children

Just like Zainab, Abdulrasheed Maryam, 36, has HIV and her 11-month-old son also lives with the virus.

She also attributed his status to her failure to attend antenatal care.

According to the mother of six, her other children are HIV-negative and regrets not taking the necessary precautions to protect him from the disease.

Maryam said, “Life has not been easy for my 11-month-old son, since I gave birth to him. I didn’t know that he would be infected. For five of his siblings, I did the right thing but I guess I took things for granted and didn’t get any antenatal care while pregnant with him.

She noted that maintenance of HIV required some level of financial stability adding, “From my tailoring and grinding machine businesses I try to ensure that everyone is happy. I don’t allow anyone to stigmatise me and my child.

“I treat the six of them equally. I have chosen to give my son the needed support but it’s not easy I must confess.”

Adamu Aishatu also shares the same regret with the two women.

However, her story is different because she is a widow, saddled with the responsibility of caring for five children alone.

Infected 15 years ago by her husband, she had been very careful to avoid mother-to-child transmission of the disease by registering for antenatal care in a government-owned hospital and giving birth to her four children there.

Unfortunately, a last-minute decision to patronise a traditional birth attendant due to cost while pregnant with her fifth child left her with a lifelong regret.

“I didn’t understand the implications,” she cried, wiping her face with the side of her wrapper.

“I have four children, three are negative, and one is positive. I didn’t go for antenatal care when I was pregnant and used a traditional birth attendant without knowing the implications of such.

“All I want now is for my child to be healthy. Now I am scared of what the future holds for him. I am afraid that he would get sick and not survive.”

With the present state of the economy, the widow lamented life has been tough without her husband.

“Taking care of an HIV-positive son and his other siblings has been difficult. The money I make from selling kunu geda (pap) is what we survive on. Eating a nutritional diet requires money while educating the children is difficult,” Aishatu lamented.

Women HIV burden

HIV/AIDS is a global public health challenge and a major threat to socio-economic development in Nigeria.

Gombe state belongs to one of the HIV-burdened states in Nigeria.

Gombe State map

According to the 2013 National Reproductive Health Survey Report, Gombe state ranked 13th in the country with a 3.4% prevalence rate.

In 2005 60,300 people were living with HIV/AIDS in the state, out of which 10,200 were youth aged 15-24years, while 16,200 children were orphaned by the disease and 23,000 lives were lost to the disease, according to the National Agency for the Control of AIDS reports in 2013.

Recent global estimates by the Joint United Nations Programme on HIV/AIDS indicate that women carry the burden of HIV/AIDs, and it is still the leading cause of death for women of reproductive age.

Pregnant women living with HIV are at a greater risk of experiencing pregnancy complications compared to women who are HIV-negative.

Pregnant women living with HIV are also at increased risk of life-threatening infections such as sepsis and opportunistic infections, including TB, pneumonia, and meningitis.

Pregnant woman

Image Source: Rolling Stone

Experts say maternal deaths are preventable when women have access to quality antenatal and postnatal care, and safe delivery attended by skilled personnel that is supported by quality emergency obstetric care.

While the death of a mother is a tragedy in itself, it also has devastating effects on the survival of her children, the economic stability of the family, and the productivity of the community.

Experts say providing care and support for women living with HIV during pregnancy, delivery, and the postpartum period presents unique challenges not only for the prevention of mother-to-child transmission, also known as vertical transmission but also for the woman’s health and survival.

According to recent global estimates by UNAIDS, 81 per cent of pregnant women living with HIV were receiving antiretroviral therapy to prevent vertical transmission of HIV through PMTCT programmes, which prevented up to 220,000 new infant infections.

It is stated that despite these successes, an estimated 160,000 children were newly infected with HIV, lamenting that antiretroviral therapy coverage has not significantly increased since 2014.

According to UNAIDS, this indicates the importance of renewing focus on ensuring the prevention of vertical transmission of HIV from mothers to infants.

Burden of Child HIV in Borno State

In December 2023, the Gombe State Agency for the Control of AIDS revealed that no fewer than 5,340 children were presently undergoing treatment for HIV/AIDS out of 31,450 persons with the viral disease.

Healthwise during the commemoration of the 2023 World AIDS Day, the Project Manager of the agency, Dr Suraj Abdulkarim, said the failure of some pregnant women to get tested may be responsible for their babies testing positive for HIV.

He further disclosed that the state is still grappling with a lack of test kits, especially in primary healthcare facilities.

HIV self-testing kit

He said, “31,450 people are on treatment, 5,340 of them are children. Test kits are not available in most primary healthcare facilities.

Some pregnant women not getting tested during the antenatal stage led to delivering babies with HIV,” Abdulkarim stated.

In the same month, the Programme Officer of the agency, Hassan Mohammed, raised the alarm over the rising number of children infected with HIV in the state.

He revealed that factors fuelling the spread were the high prevalence of gender-based violence and homosexuality among adolescents, adding that the governor had recently suspended some big names from offices due to sexual harassment of minors in society.

He added, “In SACA, we believe, these are one of the drivers towards HIV in Gombe State. Small children and even mad people are being raped. That is why they transfer these kinds of infections to the society. So it became a problem within our society these days.

According to the North-East Zonal Coordinator of the National Centre for the Control of Aids, Tobia John, while speaking on the prevalence rate of people living with HIV/AIDS in the North, amid rise in new AIDS-related deaths; there has been a surge in the number of children born with the virus.

He ascribed the development to a lot of socio-cultural factors and poverty at the same time.

200 out of 3,000 HIV-positive women pregnant

The Medical Director of the State Specialist Hospital, Dr. Mu’azu Shuaibu, while Healthwise, revealed that out of the approximately 3,000 HIV-positive women accessing services at the facility, 200 are presently pregnant.

HIV-positive pregnant women -Source Medscape

He said the support provided by the hospital has contributed to a decline in transmission levels.

“We provide family planning services because one of the key strategies in preventing mother-to-child transmission of HIV is to prevent unwanted pregnancies.

If a woman is pregnant without knowing or planning for it, the chance that the baby will be infected is high. We offer family planning services specifically to HIV-infected patients of reproductive age,” he said.

Shuaibu elaborated on the comprehensive care provided to pregnant HIV-positive women, adding, “For those already pregnant, we offer special antenatal care, including counselling on nutrition, exercise, and the benefits of exclusive breastfeeding.

“During delivery, we provide specialized services, and after birth, we administer the drug Nevirapine to the babies to prevent infection.

“Before pregnancy, we provide counselling. When they get pregnant, we encourage them to take their medication and help them conceive when their viral load is very low.

He further revealed that from January to May, no fewer than 200 pregnant women have accessed services at the Specialist Hospital.

“Currently, we have over 3,000 HIV-infected patients accessing services at the hospital.

Of these, 200 have been transferred to antenatal care, meaning they are receiving specialized care at our clinic. We will monitor them up to birth,” Shuaibu assured.

He noted that cases of HIV-positive infants are rare among those who receive ANC at the facility.

Most of the time, we get HIV-positive infants from unbooked cases—those who come to the facility only during delivery without prior ANC.

“These women often have an unknown status and uncontrolled viral loads, increasing the risk of transmission to their babies.

For those we have mentored and monitored from the ART clinic and moved to antenatal care, the incidence of transmission is very low. In the last two years, we have had only two or three such cases, which is a 99 per cent success rate in preventing transmission at our facility,” he informed.

According to United Nations Children’s Fund data, progress in reducing mother-to-child transmission of HIV has been dramatic since the introduction in 2011 of the ‘Global Plan towards the Elimination of New HIV Infections among Children and Keeping their Mothers Alive’ – largely because of increased access to PMTCT-related services and an increased number of pregnant women living with HIV being initiated on lifelong antiretroviral medicines.

“But progress is not fast enough to reach the 2025 targets set by the Joint United Nations Programme on HIV/AIDS, and partners as part of the UNAIDS Global Strategy to End AIDS.

Acceleration of treatment for all pregnant and breastfeeding women living with HIV is still needed to achieve the elimination of new infections among children and halve HIV-related deaths among pregnant women and new mothers,” the report stated.

Preventing mother-to-child transmission

According to the United States Agency for International Development, comprehensive HIV care, including early HIV testing and immediate linkage to treatment for infants diagnosed with HIV, is crucial to ensure a healthy infant.

USAID noted that globally, 62 per cent of infants born to pregnant women living with HIV received a virologic test within the first two months of birth.

It stated, “The fast rate of HIV progression and the high morbidity and mortality among infants and children with perinatally-acquired HIV means that early infant diagnosis and rapid enrollment of infants living with HIV in care and treatment programs should be a priority.

“Several countries have achieved elimination of vertical transmission, but none of these countries are in sub-Saharan Africa, a region that accounts for 90 per cent of the global burden of vertical HIV transmission.

Preventing mother-to-child HIV requires efforts

Peer Health Educator at Town Maternity, Gidan Magani, Safiya Suleiman, said preventing mother-to-child transmission in the state required concerted efforts.

According to her, weekly, she educates 20 HIV-positive mothers, adding, “It depends on the period they come and they could be as much as 20 or less. They come here to pick their drugs and we also educate them.

Highlighting the challenges faced by the women, she lamented that most of them are malnourished and do not usually have transportation to get to the facility to pick up their antiretroviral drugs.

Suleiman said ignorance, poverty and failure to get antenatal care during pregnancy were part of the reasons for the surge in child HIV in Gombe.

She said, “Lack of ANC is a major factor. The lack of delivery at hospitals could be blamed for the rise. Those of them who delivered at home through TBAs don’t have adequate information about safe delivery, and many of such deliveries are emergencies, and by so doing, the child could be infected.

Suleiman also blamed the rise on stigmatization, saying, “We still have instances of stigma but as Peer Health Educator, you need to counsel those involved to desist from such act.

“A case at hand was that of a woman whose neighbours told their children that they shouldn’t touch a client’s children or accept water from them but we try to tell them not to do that as HIV is not spread from water.

“I believe that increased sensitisation and awareness campaigns will go a long way in curbing stigma, and discrimination as well as protection of unborn children.”

Preventing mother-to-child HIV is a duty – TBA

For Farouq Amina, a traditional birth attendant in Kwami, preventing mother-to-child HIV transmission has been a duty she upholds.

According to her, she promptly refers her clients to the nearest Primary Health Care Centre or a diagnostic lab before accepting them.

A traditional birth attendant at work. Image credit: The Elephant

According to her, “I know the dangers involved in delivering children at home. I usually ask them to get a doctor’s report or laboratory results to know their status. I can’t afford to joke with their health.

TBAs must adhere to medical ethics

Amina warned her colleagues to operate professionally, stating, “We can’t afford to be multiplying HIV- positive children in the state through our carelessness.

“As an auxiliary nurse, I wish my colleagues could seek knowledge and reach out to medical professionals when in doubt.”

Another TBA, who simply identified herself as Khumira and operates around the Nafada axis of the state said, “My family members are known for delivering children at home. I got the gift from my parents.

Women always complain of transport to PHCs to get tested but that is not the case here for many of them. It is closer and they must get tested before I attend to them.

“For me, getting comprehensive HIV care, including early HIV testing and immediate link to treatment for infants diagnosed with HIV is crucial to ensure a healthy infant. This is one of the things we know and once a woman has tested positive, I refer immediately.

Progress in eradication, not enough – UNAIDS

The UNAIDS Country Director, Dr Leo Zekeng, during the 2024 Nigeria HIV Prevention Conference for Youths, organised by NACA, said the progress made so far in achieving targets set for eradication of HIV in the country was not very impressive yet.

He said, “We can’t be satisfied because, in 2021, the world made a commitment to reduce new HIV infection by 83 per cent and reducing the infections by 83 per cent meant that by 2025, we would have had 370,000 new infections but the data for 2022 suggests that we have 1.3 million new infections.

“So we can’t be satisfied with that kind of performance that did not reduce significantly the number of new infections.

“For a country like Nigeria, it means that the target was 22,000 but when you look at the data for 2022, we had 74,000 new infections.”

Zekeng, however, added that about 11 countries mostly from the east and southern Africa have attained a 66 per cent reduction in HIV infection based on pre-2025 target assessment.

According to him, out of the 11 countries, nine are from the east and Southern Africa, while the other two – Cameroon and Ivory Coast – are Nigeria’s neighbours.

Zekeng said the progress attained by the 11 countries serves as a testimony that reducing HIV infections is achievable with determination.

He said the target set by Nigeria was achievable but that what was needed was the strengthening of efforts and doing all the things needed to be done.

‘ASWHAN committed to HIV prevention’

Gombe State Coordinator, Association of Women Living With HIV/AIDS in Nigeria, Margaret Maisanda, appeared dissatisfied with the state government’s handling of the epidemic and wants members involved in PMTCT programme implementation.

According to her, they can serve as mentors and help prevent transmission.

Maisanda said, “Make ASWHAN the face of PMTCT in Nigeria to end mother-to-child transmission of HIV. No child should be born with HIV. The burden lies with us; make ASWHAN partners in this fight.

“We are calling on Global Fund, the PMTCT Implementing Partners to include ASWHAN in the GC7 PMTCT implementation, we are the mentor mothers, we carry the pregnancy and we deliver the children in the labour rooms.

We are the only ones that can prevent the transmission. Only a mother can protect her baby with her life,”

While calling on the government, donors national and international and all relevant stakeholders in the fight against HIV/AIDS, to accelerate investment in HIV programmes for women, Maisanda said, “We call on small and medium enterprise organisations to include ASWHAN in their skills acquisition and economic empowerment programmes, to train our women on different business skills, support them with small grant to boost their businesses and support us to form cooperatives.

“We want our women to be economically empowered. Women Living With HIV are suffering with no source of income and are burdened with children and other dependents to take care of.

“Support ASWHAN with economic empowerment and life-building skills to empower women living with HIV to live a decent and productive life.

“Out of the 1.6 million people living with HIV in Nigeria, 56 per cent are women. Please support us to alleviate poverty among WLWH.”

Gombe HIV burden, under control – NACA zonal coordinator

Dr. Tobias John, the NACA Zonal Coordinator, said the HIV epidemic in the North-East is being brought under control, with Gombe State achieving significant progress.

He said, “I would like to say that Gombe has achieved epidemic control. Yobe has yet to achieve it, and Borno and Taraba are making progress. As of the last quarter of 2023, the two 95-95 targets were very satisfactory, similar to Adamawa and Bauchi States.”

Dr Tobias John

He attributed Gombe’s success to a pragmatic approach, adding, “They are likely ahead in the North-East. When the validated data for the first quarter of 2024 is available, we will be able to see the levels across the six states.

He acknowledged the difficulty of preventing mother-to-child transmission of HIV, stating, “Last year, we conducted a study in Gombe to identify factors responsible for the surge in paediatric HIV/AIDS transmission.

“Similar issues were found in Taraba. The gap in paediatric transmission widens each quarter, often due to TBAs.”

John explained that many women still prefer TBAs over healthcare facilities due to attitudes and financial concerns.

He explained, “Women often choose TBAs for deliveries because they are less expensive than healthcare facilities. However, TBAs often handle emergencies, increasing the risk of HIV transmission.”

To address these challenges, John suggested mobilizing and educating TBAs.

“We need to change their orientation and involve them in referring pregnant women to healthcare facilities. Many TBAs are young and could be educated on HIV transmission, prevention, and treatment,” he said.

He emphasized the need for joint action and sufficient funding to support real-time interventions.

The national coordinator also proposed enhanced premarital testing within religious communities, suggesting PCR testing over a three-month period to improve accuracy.

“We have issues with premarital counselling and testing. Treatment as prevention means anyone adhering to treatment and achieving viral suppression cannot transmit HIV. However, couples may marry during the window period when the virus is undetectable. We need a minimum of 90 days for testing to ensure accurate results,” he said.

John further called for increased awareness, particularly among religious leaders in the North-East.

“We need to promote counselling and testing, ensuring anyone reactive is placed on medication to achieve viral suppression. This approach can help prevent new infections and make HIV a thing of the past.” He maintained.

 


Spread the love
Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Copyright © 2023 Instant News Naija

× How can I help you?