How are children with HIV faring in Nigeria?
HIV/AIDS is an infectious illness that also affects children. In this article by Sade Oguntola, experts warn that many children living with HIV in Nigeria are being left to die due to gaps in Nigeria’s HIV programming.
Haruna, (not real name) a 10-year-old orphan born with HIV, lives with his aged grandmother and brother. His grandmother took over his care after his brother moved to another city to work.
Months after, he became terribly ill and died in June 2019 because he had defaulted on his HIV medications. The grandmother, who had difficulty moving, could not ensure he went to the clinic for medical care or to refill his prescription.
Kunle, a 13-year-old boy living with HIV, also died at the University College Hospital after he developed an infection. Despite all that was done to save him, he did not survive.
Abass and Sherifat are siblings whose mother passed away a few years ago, leaving them to be cared for by their security guard father. The five-year-old Abass took ill frequently and at the nearby clinic that his aunt took him to for treatment, tests revealed he had HIV.
However, Abass and Sherifat’s father insisted that his children would not be separated because Abass has HIV. The aunt asked that Sherifat stay in her house and Abass be moved to an orphanage.
Abike, a 19-year-old stewed ponmo meat seller in Lagos, claims her mother was stigmatising her. The mother who works at an orphanage had refused to let her stay at the orphanage. Now, she is with a fatherless, seven-month-old baby that tested positive for HIV, with no job or home.
With assistance and support of medical workers at the UCH, Ibadan, her baby is no more unwell. Both have commenced ARV medications, but she wants the baby transferred to an orphanage as she wants to go back to her trade or school.
These are few of Nigerian children living with HIV. The 2108 Nigeria HIV/AIDS Indicator and Impart Survey (NAIIS) indicated the prevalence of HIV among children age zero to 14 years was 0.2 per cent.
Nigeria has the highest burden of new HIV infections among children in the world. Of the 860,000 deaths under age five in Nigeria in 2013, 70 per cent were due to HIV and other infectious diseases.
Up to half of babies born to HIV-infected mothers become infected themselves either in the womb, during labour, or through breastfeeding, unless the mothers and babies are treated with antiretroviral (ARV) drugs.
But several studies suggest an additional burden for these children who have HIV, and who may also be orphans. They may suffer from rejection, stigma, psychosocial support and run an increased risk of dying.
Now, “infected children are a growing population, and they’re neglected and not integrated into society. They are emotional and physically abused. They are always living with the fear of rejection,” said Mrs Olanrewaju Ogunyide, counselling psychologist at the University College Hospital’s children’s HIV clinic.
Mrs Ogunyide declared that some children only come to know they have HIV when their care giver calls them names, shouts on them or mistreats them.
In a study among caregivers of HIV-infected children attending the Paediatric Infectious Disease Clinic of the University College Hospital, Ibadan, between November 2008 and October 2009, disclosure had been done in only 13.5 per cent of the children.
Worse still, adherence to HIV medications is poor in these children due to the degrading treatment they receive from their caregivers, including family members, a reason many are also dying.
Since they are often withdrawn, unhappy and lacked psychosocial support from caregivers, she said they find it difficult making friends and also perform poorly in school work.
Sadly, there are limited spaces for children living with HIV in Nigerian orphanages. That would have been an alternative to their family and social challenges that leave them vulnerable to loneliness and unhappiness.
”For instance, there are about six orphanages in Oyo State that readily accept them and the places are gradually overflooded,” she declared.
Nonetheless, Dr Babatunde Ogunbosin, a consultant paediatrician at the University College Hospital (UCH), Ibadan stated many Nigerians think that HIV is no longer a big issue and that Nigeria is doing everything that needs to be done about the infection.
The last survey had put Nigeria’s HIV prevalence of 1.4 per cent among people age 15 to 49 years.
He stated: “This is not true. Nigeria still has the largest paediatric population of HIV in the world; a lot of people do not know that. With the gradual withdrawal of donor funds for HIV care, costs of care are being shifted to patients. As such, stigma and a lot of non-disclosure of HIV status will continues, so also will the population of children with HIV rise in Nigeria.”
Dr Ogunbosin said many women still do not tell their husbands that they have HIV, therefore, making adherence to HIV medication very poor.
“Of course, she is going to have children, and they are likely to have HIV. It happens all the time,” he declared.
The expert decried the low number of Nigerian pregnant women that assess antenatal care, who get screened for HIV and deliver at health care facilities and if need be take HIV medications to ensure they can protect their baby from contracting the virus.
According to Dr Ogunbosin, these are some missing gaps in Nigeria’s HIV programming.
“We often focus on HIV medications and testing and all of that. But there is a whole bunch of psychosocial support that these families and children need that there is no particular attention or funding for. It is difficult, it is challenging but it is a need that must be addressed,” he declared.
He said a lot of children with HIV are still dying. “They ought not to die or suffer for what they have no hand or no role in the causation. So, there is still a big problem, with HIV,” he added.
According to Dr Ogunbosin, more programming is also required to care for children on HIV treatment transiting into adolescence who are also dying when they come to the awareness of the fact that they have HIV.
Mr Williams Marcus, proprietor, Living Word Missions, an orphanage at Ososami in Ibadan, said government helps to ameliorate the problem of children with HIV by training all homes to manage these children and then accommodate them based on their capacities.
He said building separate homes to take care of these children will create stigma and will not achieve this.
From experience, he stated, having persons living with HIV take care of these children in homes will also ensure they receive better care since they will be acting as their mentor mothers.
“Their care will not be haphazard. They understand the implication of adherence to HIV medications and they will not regulate their contact with them,” he declared.
But, Dr Ogunkunle, Project Manager, Oyo State Agency for Control of AIDS, assured that the agency had been working on closing gaps in the care of children living with HIV.
According to him, in the past, based on their needs assessment by the Ministry of Women Affairs, the agency had offered them some assistance.
Dr Ogunkunle said through a World-Bank supported project, many in school had psychosocial and educational support. They had received school books, bags and socks as well as a stipend to cover their school fees.
“One of the beneficiaries of this scheme from Oke Ogun area of Oyo State is currently a student of the Federal Polytechnic, Ede. If not for that support, I am sure that the lady will not be in a higher institution now.” Dr Ogunkunle declared.
He said, “aside from the quarterly worming exercises they had for all of them, those out of school, also benefited from skills acquisition training as well as tools to start off their learnt trades.
Dr Ogunkunle, however, stated that despite the agency’s funding challenge, people living with HIV from all the state’s senatorial districts recently received freezers, sewing machines, popcorn machines, pepper grinders and so on as a form of empowerment under Governor Abiola Ajimobi’s administration.