An HIV-free Nigeria must start with pregnant women, says expert

Gloria, early 30s, is a tailor by profession. She lives in Nassarawa, North central Nigeria. She is married, has one child and is expecting another. 

Gloria also serves as a mentor-mother at the tertiary Hospital in her community. As a mentor-mother, she coordinates the support group created for women living with HIV who access treatment at the health center. Drawing from her experience living with HIV and successfully adhering to the Prevention of Mother To Child Transmission (PMTCT) treatment, Gloria mentors other women on how to go about it.

Living with HIV

“I found out that [I’m] HIV positive in 2003,” Gloria says. A persistent fever and leg pain had forced Gloria’s family to take her to hospital for a confirmatory test. After several other tests, a doctor asked her permission to test for HIV. Gloria accepted. “So after the test he came and told me that I’m HIV positive,” she says. “He asked me if I [want] him to tell my parents. I said yes but that he should just tell my mother first.” She added.

The doctor advised Gloria to start her treatment immediately. He referred her to a tertiary Healthcare centre in a neighboring state due to the unavailability of Anti-Retroviral (ARV) drugs in her state. “On reaching there, they declared the drugs free,” she says. This made treatment affordable for her. But prior to her starting on ARV, she says her brother had initially blamed her condition on witchcraft and other estranged family members. 

He placed her forcefully on herbal treatment but when she refused to take it, he stopped paying her hospital bills.

According to UNAIDS, in 2012 an estimated 35.3 million people globally were living with HIV, 2.3 million people became newly infected with HIV while 1.6 million people died from AIDS-related illnesses.

In Nigeria, there are over three million people living with HIV and Nasarawa state has one of the highest prevalence rate at 7.5%, according to a report by Nasarawa State AIDS Control Agency (NASACA). In Nassarawa-Eggon where Gloria lives, between January and August 2013, out of about two thousand people who tested for HIV, about three hundred were HIV positive, reveals a recent report by the Local AIDS Control Agency (LACA). 

Nassarawa-Eggon, comprising of urban and rural inhabitants, is a local government area with an estimated population of one hundred and eighty three people, according to a 2006 statistics by National Population Commission (NPC).

Although there are eighty-six public health facilities and twelve private facilities in the area, only twenty-three are offering HIV Counselling and Testing (HCT) with treatment sites. However, an increased awareness about HIV and AIDS has contributed to people accessing treatment irrespective of their religious background, says a nurse at the Antiretroviral Treatment (ART) centre of one of the health facilities.

To tackle the spread of HIV and AIDS in Nasarawa state, different organizations are supporting the state government in carrying out various intervention programmes. According to a recent report by LACA, Enhancing Nigeria’s Response (ENR), Institute of Human Virology Nigeria (IHVN) and SOLINA health have trained communicators to create awareness about HIV/AIDS through drama and use of flipchart presentations; run comprehensive treatment of HIV/AIDS in tertiary and primary health centers as PMTCT sites; and offer PMTCT service, respectively.

A staff of IHVN says the organization, which has its headquarter in Abuja, has been working in collaboration with Nasarawa state government since 2006 to strengthen the work towards sustainability of HIV prevention in the state.  

“What we do here is we are providing treatment, care and support for people living with HIV/AIDS and we also emphasis on mother-to-child transmission prevention,” she says.

“To be free from HIV in Nigeria, we must start with pregnant women and the pregnant women will have to be on treatment to prevent the transmission of HIV to their babies,” the IHVN staff says.

Coping with stigmatization

Access to treatment has enabled Gloria, her husband and their HIV-negative child maintain a healthy living. But she says it was not all rosy at the beginning. There was a high rate of stigmatization in her community. “If I drink water and use cup even my mother was afraid then. She’ll tell my brothers they should not use it.” She says. Her neighbours also forbade their children from eating the food she cooked. “If I’m passing, people will be calling me ‘HIV, AIDS, HIV, AIDS’. I’ll pretend as if I did not hear.” 

Earlier this year, the Nasarawa state government passed the HIV and AIDS Anti-stigma Bill into Law to protect people infected and affected by AIDS. But not many people know about the existence of this law.

In 2004, Gloria joined a support group organized by a local Non-Governmental Organization (NGO) in her community. “I was committed there,” she says. It was at this programme she met her husband. “I [don’t even hope] someone will say this woman I like you but it takes the grace of God.” She says. Gloria said she was surprised. “After the workshop he visited her family,” she says. That marked the beginning of a relationship between them. In 2007, they got married.

Championing support group for women living with HIV

Gloria started her Prevention of Mother To Child Transmission (PMTCT) treatment in 2008. “My first baby is four years,” she says. The child is HIV negative. In her opinion, the PMTCT programme is successful because it has enabled many women who are living with HIV give birth to HIV negative babies.

The staff at IHVN agrees with Gloria. She says women are responsive to PMTCT.

“We have mother-to-mother support group where they meet once a month and talk to each other,” says IHVN staff. “We have mentor-mothers. These mentor-mothers are people that have passed through PMTCT,” she adds.

For anyone to qualify to be a mentor-mother she must have adhered to antiretroviral treatment and followed all the regulatory of PMTCT services.  These mentor-mothers guide younger women to adhere to treatment and live a positive life.

Gloria’s dedication to ensuring other women living with HIV have access to treatment and are given necessary support led her in 2010 to join the mother-to-mother support group initiated by Institute of Human Virology Nigeria (IHVN). She presently serves as a mentor-mother. But she says women are not as responsive to the programme as expected. “Women are not responding because they are ashamed,” she says. Most women are still ashamed about their HIV status. The support group was created to change this.

The IHVN staff says when women living with HIV enroll in the PMTCT treatment programme, that is when they are placed in a support group. “They come together on monthly basis to encourage each other,” says the official. Adding, “We also have some kind of incentive like transport that would support them to come for the meeting and learn from each other.”

Many women turn up for the group meetings when they are given incentives for attending. Gloria says some of the women are more interested in what they will be given for attending. “If they come this month, you give them something, next month if you did not give them, that is how they will be reducing,” she says.

The staff at IHVN says women living with HIV receive different types of incentives. “We give them free drugs, free test, lab investigations are free and we provide them with care and support packages,” she says.

The IHVN staff says the only thing is for the women to be encouraged to access treatment. “The services are there and available and they are free,” she says.

Gloria says she has to keep encouraging them to attend the support group whether or not they are given incentives. “The support group is helping me a lot.” Gloria says. “We have health talk. We discuss about personal hygiene and how they can take care of their [baby].” After the meeting, they visit one another to provide home-care support.

It is important for women to visit their clinic often, to know the state of their health. “My advice is that if a woman discovers she is HIV positive, she should visit the clinic. If she [visit] the clinic and started her drugs, they will tell her more, especially if she is pregnant,” Gloria says. The medical team will tell her to start her PMTCT immediately. 

In addition, Gloria advice the government to provide economic empowerment programme for women living with HIV to enable them contribute positively to development of their community. “So many of them have children and they are not working,” says Gloria. “A woman needs to be economically empowered to take care of her children.”

The reporter:

Jennifer Ehidiamen is a 2013 IRP New Media Fellow for International Reporting Project (IRP). She is reporting on issues of global health and development in Nigeria.