HIV/AIDS: Infant Mortality And Lactating Mothers

A cursory look at Sandra Legborsi would hardly give one the impression that she was the type that would yell easily, or get angry. A fair complexioned mother of two, Sandra is normally quiet and soft spoken, but she was far from this on December 1, 2012, the World AIDS Day (WAD).

That afternoon, she and about four other women had stood outside the entrance to the secretariat of the Nigeria Union of Local Government Employees (NULGE) in Rivers State, where the Rivers State Agency for the Control of AIDS (RWSACA) in collaboration with the State Nigeria Union of Journalists (NUJ) carried out a media interactive forum on HIV/AIDS to mark the 2012 WAD.

The Executive Director of RIVSACA, Dr. Chimezie Okeh was just half way into his presentation on the topic “Global and Rivers State HIV/AIDS up date” when the women stormed the venue of the programme and almost disrupted proceedings. It was at that point that some journalists cornered them to ascertain their grievances.

For about 20 minutes, the women, from different support groups, chatted endlessly, lamenting what they described as the indiscriminate loss of their children to HIV/AIDS, and the absence of comprehensive prevention of Mother-to-child Transmission (PMTCT) programme in the state.

“We want to be involved, we want to be part of decisions concerning our lives and our children, our voices must be heard and that is why we are here”, Legborsi yelled, tears rolling down her cheeks.

Sandra, as she is fondly called, further spoke about the problems encountered by lactating HIV – positive mothers while breast feeding their babies.

“The cost of buying infant formula is excruciating, and some of us have had to breast feed our babies born HIV negative because of inability to afford infant formula”, she said.

Mrs Legborsi then demanded for a meeting between manufacturers of baby food and HIV positive nursing mothers on modalities for making infant milk available at highly reduced prices.

She noted that since 2002, the Federal Government made a declaration to put about 10,000 HIV positive children on the national Anti-Refrovinal (ARV) Programme. In Rivers State, she said amongst other promises, the Hon. Commissioner for Health, Dr. Sampson Parker, also stated that about 50,000 people Living with HIV/AIDS (PLWHIV) will be put on free ARV treatment, but this is not working because apart from the ARV drugs, immune boosters, CD4 count test etc, are being paid for by PLWHIV.

“Most of us find it extremely difficult to afford transport fare to the treatment centres, not to talk of buying supplement drugs”, she explained.

She suggested to journalists that the solution is the implementation of a comprehensive programme at no cost to positive mothers and their children.

Aside lactating HIV – positive mothers and their infected and uninfected children, HIV positive widows in Nigeria, Rivers State inclusive, are also not accommodated under the National and State HIV/AIDS programme; she noted.

She lamented that “HIV – positive widows are subjected to very dehumanizing treatments in this country, and there is no one we can run to, we need monthly stipends for our up keeps, as is the practice in Bayelsa and other states in Nigeria.

It would be recalled that the President and state government’s decision to provide HIV positive women with free anti-retroviral treatment came only after several protests from women living with HIV over the high cost of infant formula and non-availability of treatment options for them.

However, the Medical Officer in charge of PMTCT, Federal Ministry of health (FMOH), Dr. Aisha Yusuf in a communication strategy development meeting at Abuja said the federal government is doing a lot to support HIV positive mothers.

According to Dr. Yusuf, after the 2002 declaration, the Federal Government commenced the purchase and distribution of infant formula to HIV positive mothers but later stopped because it was found that breast feeding of babies exclusively was much better in the Nigerian environment than focusing on the infant feeding due to mixed feeding commonly adopted by HIV positive mothers.

In addition to complications from mixed feeding and improper preparation of milk for babies, Yusuf said, there were also issues with water. This is because before a mother starts to give the breast milk substitute, she has to adhere to certain conditions christened AAS, meaning Affordable, Acceptable and Sustainable.

She said some of the women fail to adhere strictly to this condition due to cultural factors, noting that the mixed feeding increase the chances of infection in babies, hence the discontinuation of the distribution of infant formula to HIV positive babies in the country.

Another HIV positive mother of one, fondly called Boms who stated her ordeal, said she was forced to marry her father’s friend because of his wealth.

Like other girls of her age in Ke-Town, Degema Local Government Area of Rivers State, Boms had dreams but non of such dreams was realised before she was forced into marriage.

I returned from school one Thursday afternoon in 2003, she narrated, “and met my elder brother and my mother with a man I had always called brother. He used to visit us frequently, and the way he spoke about my late father made me feel that he must be my father’s friend”.

On this fateful day, Boms was forced to pack her luggage to join ‘brother’ who looked older than her father.

According to her, she thought it was a joke until her mother and her brother escorted her to his house, and handed her over to him as wife.

After a year of the forced marriage, she got pregnant and subsequently attended antenatal care (ANC), where the health care provider diagnosed that she was HIV positive. When she eventually told him, he calmly responded after a while, saying “its okay, I’ve also been on treatment for nearly ten years”.

Boms stated that “at that point I had no place to run to, but to enroll in the PMTCT programme in order to access treatment”.

This is only one extreme effect of the age-old marriage tradition of some African cultures. Boms’ case is only one of the practices that tend to discountenance the individual’s preferences of a spouse, mostly the women, in contracting such marriages.

Boms further hinted that at the NAC Centres, health counseling and testing (HCT) offered to women at the antenatal clinics was used as the entry point for patients selection to PMTCT.

According to her, “the PMTCT programme was also designed to provide HIV positive expectant mothers with Neviraphine (a drug that prevents mother to child transmission of HIV) administered to the women prior to labour and to the child after delivery.

She said “for three years now there has been drug stock outs in Gokana (where she resides).

People living with HIV/AIDS access treatment in only Bori General Hospital which serves over nine distant communities and some LGAs. She emphasized that “the distance alone is enough to discourage HIV positive women from accessing the facility.

Another HIV positive pregnant woman who spoke on condition of anonymity, said she had her first child in a government health facility, after which she vowed never to deliver in a hospital again.

She recalled that the hostility of the nurses and the high fee that she had to pay during her first delivery made her have subsequent births at home under the supervision of a Traditional Birth Attendant (TBA).

She explained that getting a TBA’s attention is very convenient and cheaper than giving birth in a hospital, though she takes her children to hospital for postnatal care.

These situations apparently may not have presented all the scenar associated with HIV positive pregnant women and lactating mothers, but it surely states, unequivocally, the need for more attention on these important persons in our society.

While responding to the issue as it affects the Rivers State government, the Permanent Secretary of the State ministry of Health, Dr. Godwin Mpi, noted that “the policy of the Governor Chibuike Rotimi Amaechi administration is that its free medical programme is now total and universal”.

Meaning that it is no more restricted to indigenes, children below six years and elders who are 60 years and above as it used to be, government  pays all bills for treatment.

Dr.Mpi explained that the requirement for anyone, no matter his or her age to access it is for the person to be resident in the state, law-abiding, and show proof of tax payment, if the person is of age.

This, he said, also applies to the people living with HIV/AIDS.

From the fore-going, two things are clear; the first is that lactating HIV positive mothers may have a good reason to come out boldly to protest in order to make their pathetic situation known, knowing that it is often the language the authorities understand most before addressing situations.

The second is that since the government implies that it has put everything in place for the execution of its free medical programme, which includes care for HIV positive lactating mothers and their children, there is absolute need for a close monitoring of the free medical programme in order to ascertain why it has not been fully operational, or what had warranted the lapses that culminated in the protest by the HIV positive lactating mothers.

Sogbeba Dokubo