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HIV Test and Treat: How Feasible?
Over the years, awareness in HIV/AIDS issues such as prevention, treatment, care and support have developed from stage to stage across the globe, Nigeria inclusive. In fact, approach to HIV-related issues has been diversified, including Prevention of Mother-To-Child Transmission (PMTCT) of HIV. One of the most recent approaches is what is popularly called “Option B” and “Option B+”.
The crux of the matter in PMTCT is to prevent the transmission of HIV to an unborn child from the infected mother as a fetus during pregnancy, delivery and while breastfeeding. This has been widely executed successfully globally.
PMTCT, which is a clinical intervention, has lowered new infection rates among newborns to nearly zero in many parts of the world’s developed countries. As a developing country, Nigeria had first adopted “Option B”, a clinical protocol, which provides antiretroviral therapy to HIV-positive pregnant and lactating women, and allows for HIV-free newborns.
Under Option B, the extent to which a woman access antiretroviral therapy depends on certain biomarkers, including CD4 count. Consequently, some women discontinue the medication, only to restart when their CD4 count drops below a certain level.
Newer protocols by the World Health Organisation (WHO), however, recommend that lifelong antiretroviral therapy be provided to all pregnant and lactating women living with HIV, regardless of CD4 count. This protocol, known as “Option B+,” is less complex and more efficient than Option B.
Option B+ requires increased antiretroviral therapy financing throughout a mother’s life (as well as the accompanying clinical monitoring), but ultimately saves the lives of women of reproductive age and their children.
It offers all HIV-positive pregnant or breastfeeding women life-saving Antiretroviral Treatment (ART) for their entire lives. Option B+ simplifies the ART regimen to one pill once a day making it much easier for the patient to take and far easier to implement.
Not only does this approach help to ensure mother-to-child transmission is reduced to less than 5 percent for all future pregnancies, it also maintains the mother’s health, reduces HIV transmission to uninfected sexual partners, and prevents all of her children from becoming orphaned.
The implication of Option B+ being executed effectively is that ART regimen has to be readily available at all times in all facilities. This means that necessary funds has to be available, as well as HIV test kits. The concern would thus be availability of funds to enhance procurment and distribution of the ART regimen to the various health facilities in the country.
Currently, in Nigeria, major funding to HIV/AIDS response have been donor-driven, with the President’s Emergency Plan for AIDS Relief (PEPFAR) contributing a high proportion.
At the 2016 National HIV/AIDS Prevention Conference held in Abuja, Nigeria, the Country Director, U.S. Centre for Disease Control and Prevention, Dr. Hank Tomlinson, said the U.S. Government spent 4 billion Naira in HIV response (prevention, care and treatment) in Nigeria.
Among other contributions, he said, currently PEPFAR alone has provided life-saving ARV therapy for 700,000 Nigerians. This does not include what other international donor agencies have done in this wise.
Meanwhile, the Minister of Health, Professor Isaac Adewale, said during the 2016 World AIDS Day (WAD) celebration in Abuja that over 800,000 Nigerians are currently on ARV therapy.
When this is placed pari passu with the fact that while PEPFAR alone takes care of the ARV therapy of about 700,000 Nigerians, and other international donor agencies are also key contributors, the level of contribution by the Nigerian Government in terms of funding becomes cause for concern.
This is in view of the fact that test-and-treat strategy, which is the crux of Option B+, involves an aggressive expansion of HIV testing to identify HIV infected persons, and immediate initiation of antiretroviral therapy.
For those diagnosed HIV positive, they are immediately placed on ARV without waiting for the results of laboratory investigations such as the CD4 count. That is, patients are started on ARV drugs irrespective of their CD4 count result as stipulated by the 2013 WHO PMTCT guideline.
This being the case, the question that readily comes to mind, if Option B+ must be a success, is, if the bulk of HIV response in Nigeria is donor-driven with Nigeria’s financial contributions virtually negligible, what would be the country’s fate in the face of gradual withdrawal by donor agencies in terms of funding, or what Dr. Abiola Davies calls “matching programme with funds”?
In other words, how can Nigeria sustain the demands of Option B+, or Test and Treat, in the face of inadequate financing of HIV/AIDS commodities by the government?
Dr. Davies, the UNICEF representative and HIV specialist for care cum team leader for PMTCT and Paediatrics Programming in Nigeria, believes that this scenario should not be cause for alarm because Nigeria has what it takes to make Option B+ work.
But this, as she hinted, would require some level of discipline and prudence in resource generation, distribution and management by various levels of government in the country, not just the Federal Government.
“There is non-availability of funds which has to do with domestic funding. We need to bring our domestic resources, not just at the national level, because Federal Government is putting in some money which is inadequate.
“But if you come to the level of the State and Local Government, the proport on of funding is very minimal. So, to all tiers of government, we really need to see how they can mobilise funding to finance the (HIV) response”, she said.
This is very pertinent, considering that Test and Treat means that test kits and sundry HIV consumables need to be readily available at all times in all approved health facilities in the country.
What this amounts to is that for Option B+ to succeed, the necessary test kits and HIV drugs have to be available in the about 22,726 health facilities across Nigeria, and be made easily accessible to people living with the virus. All of these boil down first to the availability of the required funds.
Taking a cue from other countries, Dr. Davies recommends that Nigeria can earmark a given percentage of crude oil sales to HIV response in the form of taxation.
“Let me say that countries that don’t have as much money like Nigeria have been able to finance it (Option B+). We look at the areas where we call innovative financing.
“In some countries they have tax. To get as much HIV/AIDS funds, you might have tax attached to petrol as well as HIV funding”’ she said.
Given the fore-going, Nigeria has two options towards making Option B+ work for its citizenry: the first is to toe the line of the new Director General of the National Agency for the Control of AIDS (NACA), Dr. Sani Aliyu, who expressed the belief that Nigeria should impress it upon international donor agencies to continue in their donations.
“I implore them all (donor agencies) not to relent in their financial and technical support to HIV prevention programmes in Nigeria”’ Dr. Aliyu said at last year’s National HIV Conference in Abuja.
On the other hand, the country can be more proactive by adhering to the reasoning of Dr. Davies to ensure a systematic means of raising funds for HIV response, not dependent on the whims and caprices of any individual, and efficient management of such funds.
“There is a need for more improved efficient management of coordination of structures, and efficient use of funds. That’s one of the major areas we need the government to improve on”, she said in an exclusive interview with The Tide.
The question is which of these options will the Government feel more comfortable with or willing to embrace?
Soibi Max-Alalibo
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Features
Empowering The Girl Child,Building A Future Where Every Girl Can Thrive ?
Every girl deserves the opportunity to learn, the freedom to dream, the right to live without fear and the chance to determine the course of her own future.
Yet, for millions of girls around the world, these opportunities remain difficult to access. Some struggle to obtain quality education, while others face discrimination, early marriage, gender-based violence and social expectations that limit their ambitions. For many, the challenge begins in childhood, when decisions about their lives are made without giving their voices the attention they deserve.
October 11, observed annually as the International Day of the Girl Child, provides an opportunity to reflect on these challenges and renew the commitment to protecting girls’ rights and empowering them to reach their full potential.
The day also raises an important question: how can societies talk about a better future for girls while some of them continue to face barriers to education, safety, equality and opportunity?
For Nigeria, where girls are growing up in communities with different social, economic and cultural circumstances, the occasion offers an opportunity to examine the progress made, recognise the challenges that remain and consider the responsibilities of families, communities and government in securing a better future for every girl.
From Recognition to Action
The International Day of the Girl Child was established by the United Nations and first observed on October 11, 2012. It was created to recognise the rights of girls and draw attention to the particular challenges they face across the world.
Its significance extends beyond a yearly celebration. It highlights the need for societies to address the inequalities that prevent girls from enjoying the same opportunities, protection and dignity as their male counterparts.
Girls have the right to education, healthcare, safety, participation and equal treatment. They also have the right to express their opinions, develop their abilities and make decisions about their futures in accordance with their age and evolving capacities.
These rights are not privileges to be granted only when families can afford them or when communities consider them convenient. They are part of the wider commitment to protecting the dignity and development of every child.
The observance also recognises that girls are not simply beneficiaries of development programmes. They are potential scientists, teachers, journalists, entrepreneurs, doctors, engineers, public servants and community leaders whose contributions can shape the future of their societies.
When girls are given the opportunity to develop their abilities, the benefits extend beyond individual achievement to families, communities and the wider economy.
The Nigerian Girl Child
In Nigeria, the experiences of girls differ considerably depending on their family circumstances, location, access to education and the opportunities available within their communities.
Some girls attend well-equipped schools, participate in extracurricular activities and receive support to pursue their ambitions. Others face difficulties that threaten their ability to complete their education or develop their full potential.
Poverty remains a significant concern for families struggling to meet basic needs. In some households, girls may be expected to undertake extensive domestic responsibilities, care for younger siblings or contribute to family income at the expense of their education.
For girls in rural and underserved communities, the distance to school, inadequate facilities, limited access to learning materials and other practical barriers may make education difficult to sustain.
Insecurity can create additional risks, particularly where families fear sending their children to school or where displacement interrupts their education.
These challenges do not affect every Nigerian girl in the same way. However, they demonstrate why protecting the rights of girls requires more than general statements about equality. It requires practical action that addresses the circumstances preventing them from accessing opportunities.
A girl who cannot attend school because her family cannot afford the necessary expenses needs support that makes education accessible. A girl exposed to abuse needs protection and access to appropriate services. A girl whose ambitions are dismissed simply because of her gender needs an environment that recognises her abilities.
The responsibility is to ensure that the circumstances of a girl’s birth do not determine the limits of her future.
Education: Opening the Door to Opportunity
Education remains one of the most important ways to empower the girl child.
Through education, girls acquire knowledge, develop critical thinking skills and gain a better understanding of their rights and responsibilities. Schooling can also expand their employment opportunities and help them make informed decisions about their lives.
An educated girl is better positioned to understand the choices available to her, participate in community life and contribute to social and economic development.
However, access to education alone is not enough. Girls must also be able to learn in safe environments, receive quality instruction and complete their education without discrimination or unnecessary barriers.
Parents and guardians have an important role in ensuring that girls are encouraged to attend school and are given the support needed to continue learning.
Schools, in turn, must provide environments where girls are protected from harassment, bullying and discrimination. Teachers can help by treating students fairly, encouraging participation and challenging assumptions that certain subjects or careers are suitable only for boys.
Government also has a responsibility to strengthen educational infrastructure, improve learning conditions and address the financial and social barriers that keep children out of school.
The goal should not simply be to enrol more girls in classrooms. It should be to ensure that every girl has a genuine opportunity to learn, complete her education and use the knowledge she acquires to build a meaningful future.
When Tradition Becomes a Barrier
Culture and tradition are important parts of community identity. They preserve history, strengthen relationships and provide a sense of belonging.
However, certain practices and social expectations can restrict girls’ rights and opportunities when they place greater value on gender than on individual ability and well-being.
In some communities, girls may be discouraged from pursuing higher education because marriage and domestic responsibilities are considered more important. Others may face pressure to abandon their ambitions or accept decisions made without their participation.
Child marriage remains another serious concern in Nigeria. When a girl is married before adulthood, her education, health, safety and personal development may be placed at risk.
Such situations highlight the importance of protecting children while encouraging communities to examine practices that undermine their rights.
Empowering girls does not require rejecting every cultural tradition. It requires preserving what strengthens communities while addressing practices that expose children to harm or deny them opportunities.
Community leaders, parents, educators and religious institutions can contribute by promoting the value of girls’ education, supporting their development and speaking against harmful practices.
A community’s strength should not be measured by how effectively it restricts the ambitions of its girls, but by how well it protects its children and prepares them for the future.
Protecting Girls from Violence and Abuse
A discussion about empowering girls cannot be complete without addressing their right to safety.
Girls may face different forms of abuse, including sexual violence, physical punishment, exploitation, bullying, harassment and harmful treatment within homes, schools and communities.
Some incidents remain unreported because victims fear blame, retaliation or public humiliation. Others may lack access to trusted adults or services capable of helping them.
The consequences can be serious, affecting a girl’s physical health, emotional well-being, education and ability to trust others.
Protecting girls requires adults and institutions to take reports of abuse seriously and respond in ways that prioritise the child’s safety and dignity.
Parents and guardians should encourage open communication so that girls feel able to report situations that make them uncomfortable or unsafe. Schools need clear procedures for reporting and responding to abuse, while relevant authorities must ensure that children can access appropriate protection and support.
Girls should also receive age-appropriate information about personal safety, boundaries and where to seek help.
Importantly, the responsibility for preventing abuse belongs to those who commit it and to the institutions responsible for protection. Girls must never be blamed for violence or exploitation directed against them.
A society that celebrates the girl child must also be prepared to defend her rights when those rights are threatened.
Health, Confidence and the Freedom to Dream
Empowerment also means ensuring that girls can grow up healthy, confident and informed about their bodies and well-being.
Access to healthcare, adequate nutrition, clean water, sanitation and accurate health information is essential to their development.
For adolescent girls, menstrual health is particularly important. Where sanitary products, private toilets or reliable information are unavailable, menstruation can create practical difficulties that affect attendance at school and participation in daily activities.
Families, schools and relevant institutions can help by providing accurate information, challenging harmful misconceptions and ensuring that girls have access to appropriate facilities and support.
Emotional well-being also deserves attention. Girls who experience discrimination, bullying, abuse or constant pressure to meet unrealistic expectations may struggle with confidence and self-worth.
Encouragement from parents, teachers and trusted adults can help them recognise their abilities and develop the confidence to pursue their goals.
A girl should not have to choose between being accepted by society and believing in her own potential.
She should be able to explore her interests, develop her talents and imagine a future that reflects her abilities, values and ambitions.
The Role of Parents, Schools and Government
Empowering the girl child is a shared responsibility.
Parents and guardians are often the first people who shape a girl’s understanding of her worth and potential. Their encouragement can influence whether she feels confident enough to pursue education, express her views and aspire to leadership.
Providing equal encouragement to girls and boys, sharing household responsibilities fairly and listening to girls’ concerns are practical ways families can promote equality at home.
Schools must ensure that girls have equal opportunities to learn, participate in activities and develop leadership skills. Teachers should challenge gender stereotypes and encourage girls to explore subjects and careers based on their interests and abilities.
Government institutions also have a responsibility to protect children’s rights through effective laws, policies, educational support and accessible protection services. Laws must be implemented, and families should be able to seek help when a child’s safety or rights are threatened.
Communities, civil society organisations and the media can support these efforts by educating the public, drawing attention to harmful practices and highlighting positive examples of girls overcoming barriers.
The media, in particular, can help change public attitudes by portraying girls as active participants in development rather than limiting their stories to vulnerability and suffering.
Together, these efforts can create an environment in which girls are protected, heard and given the opportunity to contribute meaningfully to society.
Beyond October 11
The International Day of the Girl Child is an important reminder, but the protection and empowerment of girls cannot be achieved through a single day’s activities.
It requires sustained action in homes, schools, workplaces, communities and public institutions.
It means ensuring that a girl from a low-income family has access to education, that a girl living in a rural community is not forgotten in development planning, and that a girl who reports abuse receives appropriate protection rather than blame.
It also means listening to girls when decisions affect their lives and including their perspectives in discussions about education, healthcare, safety and development.
The measure of progress is not simply the number of speeches delivered or campaigns organised. It is whether girls are safer, better educated, healthier and more able to make meaningful choices about their futures.
Every girl deserves the opportunity to grow without violence, learn without discrimination and pursue her ambitions without being limited by harmful expectations.
A Future Where Every Girl Can Thrive
The future of any society is closely connected to the opportunities available to its children.
When girls are educated, protected and encouraged to develop their abilities, they are better positioned to contribute to their families, communities and the wider society. When their rights are neglected, the consequences can extend far beyond the individual child.
As the world marks October 11, the message to Nigeria and the international community is clear: empowering girls begins with recognising their rights and continues through the practical steps taken to protect them.
It begins with a parent who encourages a daughter to remain in school, a teacher who recognises her potential, a community that rejects harmful practices and institutions that respond seriously when her rights are violated.
It also requires a willingness to question beliefs and practices that deny girls the freedom to learn, grow and participate in society.
A girl’s future should not be determined by poverty, discrimination or the assumption that her ambitions matter less than those of a boy.
Every girl deserves the chance to discover what she can become.
On this International Day of the Girl Child, the call is not merely to celebrate girls, but to protect their rights, invest in their education, listen to their voices and create a society where every girl has the freedom and opportunity to thrive.
Because empowering a girl is not simply about changing her life today. It is about helping to build a future in which her dignity is respected, her potential is recognised and her rights are protected every day.
Davies Christian Nelson & Dominic Emediong Emmanuel
Dr Davies is the Director of Publications, Rivers State Ministry of Information and Communications.
Features
Beyond Tradition As Stakeholders Seek Collaboration To End FGM In Rivers
For generations, Female Genital Mutilation(FGM) has remained one of the most deeply entrenched harmful traditional practices affecting women and girls across many societies.Sustained largely by cultural beliefs, misconceptions and long-standing norms, the practice has continued despite increasing global awareness of its severe health, psychological and human rights consequences.
In Nigeria, however, growing public awareness, stronger legal frameworks and coordinated interventions by government institutions and development partners are gradually changing the narrative.Although significant progress has been recorded, experts insist that achieving the complete eradication of female genital mutilation requires more than legislation. It demands sustained collaboration, continuous public enlightenment, community ownership and the willingness to challenge harmful practices that have endured across generations.
To this end, stakeholders in Rivers State have renewed calls for stronger collaboration, sustained public enlightenment and community ownership in the fight against Female Genital Mutilation (FGM), warning that the harmful practice cannot be completely eradicated through legislation alone.
The call was made during the Third Quarter State Technical Committee Meeting on the Elimination of Female Genital Mutilation in Rivers State, organised by the Rivers State Ministry of Health with support from the United Nations Children’s Fund (UNICEF) and other development partners.
The meeting brought together representatives of the Ministries of Health, Social Welfare and Rehabilitation, Information and Communications, civil society organisations, child protection advocates, development partners and other stakeholders committed to protecting women and girls from harmful traditional practices.
The engagement provided an opportunity for participants to review progress recorded in the state, examine persistent challenges and develop practical strategies for accelerating the elimination of FGM through stronger partnerships, coordinated interventions and evidence-based advocacy.
A major focus of the meeting was the need to broaden public understanding of what constitutes FGM. Participants noted that the practice extends beyond the commonly recognised cutting or removal of parts of the female genitalia and includes other harmful procedures that can cause lasting physical and psychological damage.
Setting the tone for the technical discussions, the Reproductive Health Coordinator, Rivers State Ministry of Health, Dr. Ebere Smith, described FGM as both a reproductive health concern and a social injustice that violates the bodily integrity, dignity and wellbeing of women and girls.
According to her, although FGM has historically been sustained by cultural beliefs and traditions in many communities, medical evidence has established that the practice exposes women and girls to avoidable health complications and psychological trauma.
“It is an injustice to the female anatomy. It is not just a reproductive injustice; it is also a social one. It affects a woman’s emotional well-being, childbirth, marriage and overall quality of life,” Dr. Smith said.
She explained that FGM can involve the use of unsterilised razor blades, knives, scissors and needles, while drawing attention to less recognised practices, including the repeated pressing of a baby girl’s genital area with hot water, which she identified as a form of Type IV FGM.
Dr. Smith noted that survivors could suffer excessive bleeding, infections, chronic pain, complications during childbirth, sexual dysfunction and emotional trauma, among other long-term health consequences.
She therefore stressed the importance of providing families and communities with accurate information to dispel misconceptions that have allowed harmful practices to persist across generations.
“Having the right information at the right time for the right people is essential,” she said, emphasising the roles of healthcare workers, parents, caregivers, traditional institutions, educators, journalists and community leaders in preventing FGM.
Speaking on progress made in Rivers State, the UNICEF Desk Officer in the Rivers State Ministry of Social Welfare and Rehabilitation, Dr. Victor Iseberetonma, expressed optimism over the impact of sustained advocacy and community sensitisation.
He disclosed that sensitisation structures established in about 60 communities were conducting house-to-house campaigns, church outreaches and market engagements aimed at educating residents on the dangers of FGM.
Iseberetonma also noted that an increasing number of traditional rulers and community leaders were demonstrating commitment to ending the practice within their domains.
He described the willingness of some monarchs to formally abolish FGM in their communities as an important milestone, stressing, however, that the ultimate objective remained the complete eradication of the practice across Rivers State.
In his technical presentation, UNICEF Facilitator, Mr. Uchenna Unah, cited findings from the 2024 Nigeria Demographic and Health Survey (NDHS), which showed that the prevalence of FGM among women aged 15–49 had declined from 20 per cent in 2018 to 14 per cent in 2024.
Despite the decline, Unah said FGM remained a significant public health and human rights concern, noting that 85 per cent of girls and women who underwent the practice experienced it before the age of five.
He further highlighted encouraging changes in public attitudes, stating that 71 per cent of women and 74 per cent of men surveyed believed that FGM should not continue, while a similar majority affirmed that no religion requires the practice.
He urged stakeholders to sustain evidence-based advocacy, strengthen community engagement and intensify public enlightenment to ensure that the declining prevalence ultimately translates into the complete elimination of FGM.
Also contributing to the discussions, the State Coordinator of the Child Protection Network (CPN), Rivers State, Inyinyi Irimagha, challenged the continued use of the term “female circumcision”, describing it as medically inaccurate.
She explained that circumcision refers to the removal of the male foreskin and should not be used to describe harmful procedures carried out on the female genitalia.
Irimagha said collaboration between the Rivers State Ministry of Social Welfare and Rehabilitation, Child Protection Network, UNICEF and other partners had strengthened community advocacy through survivor groups, adolescent networks, male champions and traditional rulers.
She also highlighted the need to increase awareness of Type IV FGM, particularly practices that communities may not recognise as forms of genital mutilation.
According to her, the absence of cutting does not mean that such practices are harmless, as damage to delicate tissues and nerves can result in long-term health and reproductive complications.
Beyond the formal presentations, discussions with participants revealed that misconceptions about FGM remain widespread.
Some participants admitted that they had previously associated FGM exclusively with the physical cutting or removal of parts of the female genitalia and were surprised to learn that other harmful practices are also recognised internationally as forms of FGM.
The discussions further highlighted the influence of culture and intergenerational traditions on perceptions of women’s health. Some participants recalled practices that had been passed down for generations without sufficient consideration of their medical implications.
One cultural practice mentioned during the engagement involved placing a snail between the legs of a woman after childbirth based on the belief that its slimy nature could help control bleeding.
Participants agreed that while cultural traditions remain important to communities, practices that pose risks to human health should be subjected to scientific scrutiny and discontinued where necessary.
A resident, Sampson, described the enlightenment as an eye-opener, noting that many people had traditionally believed that applying hot water to a newborn girl’s genital area was simply a routine hygiene practice.
He said greater public awareness was needed to ensure that families did not unknowingly expose their children to harmful practices.
Another participant, DollyPur, stressed the importance of creating safe spaces for community dialogue, saying that people often continue harmful practices because “everyone else” appears to be doing the same thing.
She noted that open discussions involving parents, community leaders and other stakeholders could help communities understand the health consequences of harmful traditional practices and encourage behavioural change.
The stakeholders consequently agreed that the elimination of FGM requires sustained cooperation among government institutions, healthcare professionals, traditional rulers, religious leaders, civil society organisations, development partners, the media and communities.
They emphasised that continuous public enlightenment, accurate health information and community-led interventions remain critical to correcting misconceptions, changing attitudes and protecting the health, dignity and rights of women and girls across Rivers State.
Christian Nelson Davies & Ekemini Victor Sunday
Dr Davies is the Director of Publications, Rivers State Ministry of Information and Communications, and Ekemini, an intern
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