HIV/AIDS: Bridging Nigeria’s PMTCT Gaps

Tomorrow  marks the 24th edition of the World AIDS Day (WAD). It is a day aimed at drawing the world’s attention towards ensuring universal access to HIV prevention, treatment, care and support.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), another goal of the 21st Century of WAD is to let countries understand the need to remove laws that discriminate against people living  HIV/AIDS.

The World AIDS Day was first conceived in August 1987 by James W. Bunn and Thomas Netter, two public information officers for the Global Programme on AIDS at the World Health Organisation in Geneva, Switzerland. Bunn and Netter took their idea to Dr. Jonathan Mann, Director of the Global Programme on AIDS (now known as UNAIDS).

Dr. Mann like the concept, approved it, and agreed with the recommendation that the first observance of WAD should be December 1, 1988.

Bunn, a broadcast Journalist on a leave-of-absence from his reporting duties at Kpix-TV in San Francisco, recommended the date of December 1 believing it would maximize coverage by Western news media. Since 1988 was an election year in the United States, Bunn suggested that media outlets would be weary of their post-election coverage and eager to find a fresh story to cover.

Bunn and Netter determined that December 1 was long enough after the election and soon enough before the Christmas holidays that it was, in effect, a dead spot in the news calendar and thus perfect timing for WAD.

Earlier June 18, 1986, KPIX’s “AIDS lifeline” (Community education project initiated by Bunn and KPIX special projects producer, Nancy Saslow) was honoured with a Presidential Citation for Private Sector Initiatives presented by President Ronald Reagan.

Due to his role in “AIDS Lifeline” Bunn was asked by Dr. Mann, on behalf of the U.S. government, to take two-year leave-of-absence to join Dr. Mann, an epidemiologist for the centres for disease control, and assist in the creation of the Global Programme on AIDS for the United Nations’ World Health Organisation which is currently the longest running disease awareness and prevention initiative of its kind in the history of Public Health.

The Joint United Nations Programme on HIV/AIDS became operational in 1996, and it took over the planning and promotion of WAD. Rather than focus on a single day, UNAIDS created the World AIDS Campaign in 1997 to focus on year-round communications, prevention and education.

In its first two years, the theme of WAD focused on children and young people. These themes were strongly criticized at the time for ignoring the fact that people of all ages may become infected with HIV and suffer from AIDS.

But the themes drew attention to the HIV/AIDS epidemic, helped alleviate some of the stigma surrounding the pandemic, and helped boost recognition of the problem as a family epidemic.

In 2004, the WAD campaign became an independent organisation. Each year, Popes John Paul 11 and Benedict XV1 released greeting message for patients and doctors on WAD.

In 2007, the U.S. White House began marking WAD with the iconic display of a 28-foot AIDS Ribbon on the buildings North Porticio. The display, now an annual tradition, quickly garnered attention, as it was the first banner, sign or symbol to prominently hang from the White House since the Abraham Lincoln administration.

In 2001, the United Nations General Assembly (UNGASS) discussed HIV/AIDS prevention as a necessity in dealing with the global pandemic. The session made a declaration of commitment on HIV/AIDS, universal access to HIV prevention, care and support, the goal of which was to reduce Mother-to-child Transmission (MTCT) globally by 50 per cent.

Statistics showed that Prevention of Mother-To-Child Transmission (PMTCT) services that commenced in Nigeria in 2001 in six tertiary health facilities has 46 per cent HIV prevalence in antenatal clinic with an estimated 85,450 HIV exposed infants at risk of MTCT annually. The percentage of pregnant women tested who received antiretroviral therapy to prevent MTCT was 32 per cent.

Nigeria currently lacks a coordinated system of reporting the data required to calculate the gap. The exact number of pregnant women and those on ARV prophylaxis are not known. Also, current record of antenatal care attendance makes the figure of HIV positive pregnant women at best guesstimate.

Nigeria’s PMTCT programme established in 2001, has made some in-roads. Such progress include increase in PMTCT sites from 67 in 2004 to 684 in 2010, and number of pregnant women counseled and tested for HIV in the country, which was 18,554 (2004) to 1,733,175 in 2010. Also, the number of HIV positive pregnant women receiving complete course of ARV proplylaxis increased from 645 (2004) to 45,842 in 2010, though this is far from making the required impact.

During the first stakeholders forum on HIV/AIDS in Gokana Local Government Area of Rivers State, stakeholders noted that the nation needs to do much more to be able to attain the PMTCT goal set at UNGASS in 2001.

According to the document of the National Strategic Plan for 2010-2015, to catch up, Nigeria must increase PMTCT coverage to 30 per cent based on the last sero-sentinel survey carried out in 2010.

It is estimated that more than 60 per cent of Nigerian’s population live in rural areas, most of who are under-served in terms of social amenities. Also, facilities that provide services are concentrated in the urban areas, particularly in secondary and tertiary health facilities.

The result is that many women decline to use hospital-based antenatal care services due to non-availability of social amenities.

The 2010 edition of Nigeria Demographic and Health Survey (NDHS) says 46 per cent of pregnant women in rural areas do not receive antenatal care (ANC) from health professionals. A good number of those who use ANC drop out and, ultimately, only 24 per cent deliver in facilities with trained health attendants.

The implication is that PMTCT programme will ostensibly miss the opportunity of reaching those HIV positive pregnant women outside the health care system.

Some of the challenges to effective PMTCT programmes, according to Dr. Abiola Davies, HIV/AIDS specialist, UNICEF, are largely donour driven with insufficient government supervision, poor integration of HIV in reproductive health services, and family planning as well as weak health systems.

Others, she said are early infant diagnosis (EID) to all PMTCT sites and children hospitals, wide gap between attendees and deliveries in health facilities as well as poor coordination, Monitoring and Evaluation of PMTCT services.

According to Mr. Sola Ogudipe, National Coordinator of Journalists Alliance for PMTCT in Nigeria, in 2010, about 390,000 children aged under 15 became infected with HIV. Almost all of these infections occurred among low and middle income countries, while more than 90 per cent are the result of MTCT during pregnancy, labour and delivery, or breast feeding.

Consequently,  Dr. Golden Owhonda, Rivers State AIDS/STI control programme stated that Nigeria tops the list of countries with the largest burden of children with HIV/AIDS and those requiring ARV therapy, with 2.1 million children living with HIV globally in 2008 and Nigeria accounted for 220,000 or over 10 per cent.

Most of these children were infected through MTCT. This, however, can be attributed to the low coverage of PMTCT services in Nigeria. Subsaharan Africa, alone accounts for over 90 per cent of global infections in children.

The consequences of PMTCT gap according to Dr. Chimeizi Okeh, Executive Director, Rivers State Agency for the Control of AIDS (RIVSACA) in Nigeria are numerous. They include: from social to economic issues, more women dying from HIV/AIDS – related ailments as a result of their inability to access treatment, more babies being infected with the HIV; and increased maternal mortality and neonatal deaths.

The Director General, National Agency for the  Control of AIDS (NACA), Professor John Idoko while fielding questions from journalists during the 2011 WAD, noted that “currently in Nigeria, there are 446 anti-retroviral treatment sites, 675 PMTCT sites, 1046 HIV counselling and testing sites, while the assessment of new treatment and counseling sites is on-going with plans to provide access to 20,000 patients in the next two years.”

There is no doubt that Professor Idoko made a policy statement by that declaration. Unfortuantely, as at press time, little has been done to provide access to 20,000 patients as he stated. This, in essence, summarises the problems facing PMTCT in Nigeria.

Nigeria’s PMTCT needs, therefore, require all hands to be on deck and resources to be committed into new and proven strategies that are holistic in nature. These include ensuring that women of reproductive age are empowered with information that will help them protect themselves from acquiring the infection.

This invariably can be done by massive awareness creation by the media and for various stakeholders to partner with the media to achieve effective and consistent enlightenment, and to promote sustainable behaviour changed to reduce vulnerability to the virus.

Also, family planning (FP) services should be made more accessible by integrating it and HIV services to increase HIV positive women’s access to both services. This will automatically reduce unwanted pregnancies amongst women living with HIV/AIDS.