Opinions

Challenges in mother-to-child transmission of HIV

Although the global community was recently ensnared by COVID-19, an infection caused by severe acute respiratory syndrome, prior to its emergence, HIV (human immunodeficiency virus), an infection also feared as COVID-19 had been in existence. The latter was merely more prominent as it killed with speed and in high numbers which led to a global lockdown including in Nigeria and altered peoples’ normal way of life with preventive measures and protocols.

HIV is a virus that attacks the body’s immune system and if not treated, it can lead to AIDS (acquired immunodeficiency syndrome). Literally, it currently has no cure. It means that people who get HIV infection will live with it for a lifetime. From WHO statistics (2018), approximately 37.9 million people had acquired HIV globally. Out of the figure, 1.8 million were children (below 15yrs). Sub-Saharan Africa got 90 per cent. Within, HIV/AIDS Indicator and Impact Survey (NAIIS) 2018 estimates that there are 1.9 million people living with HIV in Nigeria. The incidence of HIV in 2018 was estimated at 8 per 10,000 persons, whilst prevalence of HIV among adults age 15-64 years was 1.4 per cent, and among children age 0-14 years – 0.2 per cent.

However, the good news is, from records, people living with HIV (PLHIV) who get effective HIV treatment can live long, healthy, normal lives, and also protect their partners. Hence, with timely detection and disclosure, there’s no cause for alarm.

For instance, a lady; very eloquent, energetic and nice-looking, who was diagnosed HIV-positive about a decade ago, during interactions recently in Calabar, Cross River State, attested to living a normal life despite her status. Not only that she successfully completed her undergraduate programme in a tertiary institution amid the development, with proper medical care, she goes to work freely like any other persons, and fascinatingly, in a serious relationship for marriage. She discloses her status to peoplefreely and boldly according to her, and gives counselling on preventive measures as well as guides on ways to manage the infection if tested positive. Apart from her job in an organization to make ends meet, she runs an NGO (Non-government organisation) for advocacy on HIV/AIDS towards sensitising the public.

This story is affirmative on account of her early detection of the infection, hence able to put it under control effectively. Perhaps, her case would have been different if she didn’t discover the ailment in time. This therefore justifies the sense in undergoing diagnosis, particularly running a test for early detection considering that HIV may begin with diverse symptoms. For example, depending on peculiarity, some people may have flu-like symptoms within two to four weeks after infection (called acute HIV infection). These symptoms may last for a few days or several weeks. Possible symptoms include: fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers.

On the other hand, some people may not feel sick at all during acute HIV infection which is the first stage. So, these symptoms don’t mean people have HIV infection as other illnesses can also cause these same symptoms. Suffice to say that the only way to conclude that it is HIV infection is by undergoing a requisite medical test. Ideally, it is necessary to see a healthcare provider whenever these symptoms occur and also whenever exposed to HIV. Getting tested for HIV is the only acceptable way to be sure. For emphasis, detection can be done with great accuracy using WHO prequalified tests within a nationally approved testing strategy. In Nigeria, presently, people can use self-testing techniques outlined by health experts to determine their HIV status through rapid diagnostic tests that provide accurate and same-day results.

A critical point that cannot be overemphasised is that HIV/AIDS have claimed millions of lives, and still with no cure. And more critical and alarming is the mother-to-child transmission (MTCT) of HIV mostly through breast feeding, hence preventive measures essentially for women of reproductive age must be placed on the front burner. From report, the National Strategic Plan (NSP) targets that 95 per cent of all HIV positive pregnant and breastfeeding mothers would receive antiretroviral therapy; 95 per cent of all HIV-exposed infants would receive antiretroviral prophylaxis; and 95 per cent of all HIV-exposed infants have early infant diagnosis within six to eight weeks of birth. This is commendable.

Unfortunately, field observations show that poor access to formal public healthcare; insufficient Prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services; inadequate funding for HIV activities by states; poor data reporting system; low Pediatric HIV case identification;poor responses for children living with HIV; ineligible improvement in ANC and facility delivery uptake still stand as barriers.In summary, socioeconomic and sociocultural factors remain major barriers to the success of PMTCT in Nigeria today.

It must also be noted that activities that put individuals at greater risk of contracting HIV include: having unprotected sex; having untreated sexually transmitted infection (STI) such as syphilis, herpes, chlamydia, gonorrhea and bacterial vaginosis; and sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs. Others are receiving unsafe injections, blood transfusions and tissue transplantation, and medical procedures that involve unsterile cutting or piercing; and experiencing accidental needle stick injuries, including among health workers. And if eventually tested HIV-positive, without requisite treatment, it typically, dangerously progresses to Stage 3; i.e. Acquired Immunodeficiency Syndrome (AIDS).

The crux is that the fight against HIV/AIDS demands unremitting efforts. In particular, health and sex education, PMTCT, reduction of perinatal transmission, screening of blood and blood products need progressive drives. A sustained sensitization and synergy on HIV/PMTCT for a healthier tomorrow as WHO and UNICEF spearhead is pertinent. As the PMTCT programmes offer a range of services for women of reproductive age living with or at high risk of HIV to maintain their health and prevent their infants from acquiring HIV, access prior to conception, and throughout pregnancy, labour and breastfeeding is indispensable.