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Local Policy Frustrates HIV Prevention Programme

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A woman with a baby on her back walks towards the Primary Health Center in Masaka, Nigeria. Image by Ameto Akpe. Nigeria, 2013.

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(L-R) Ruth Aliyu, 28, Mercy Wasa, 41 and Helen Momoh, 29, and (seated) Linda Alkali, 26, are part of a support group for HIV positive pregnant women called "Mentoring mothers." Image by Ameto Akpe. Nigeria, 2013.

At the clinic in Masaka, a community in the HIV-AIDs endemic north-central region of Nigeria, many infected pregnant women drop out of the free Prevention of Mother-To-Child-Transmission (PMTCT) programme due to a routine transfer policy.

The programme, funded by the United States (US) President's Emergency Plan for AIDS Relief (PEPFAR), provides free Human Immunodeficiency Virus (HIV) testing, counseling and treatment to patients in over 1, 335 sites across the country.

When a woman accesses antenatal care at rural health care centers like the Masaka Primary Health Center (PHC) she receives routine counseling and voluntary testing. If she is HIV-positive, she will be offered an option to join the PMTCT programme at no cost.

The PMTCT is a scheme aimed at eliminating the transmission of HIV from mother to child during pregnancy, labour and breast feeding. After the initial services some women are transferred to the secondary health center in another locality.

Linda Alkali, 26, an HIV-positive mother of two and member of the ‘mentoring mothers’ support group at the Masaka health center says that so many women are lost through this process, leaving them even more vulnerable to the influences of faith based organizations or Traditional Birth Attendants which many women patronize.

Alkali, who was diagnosed during her first pregnancy at the same clinic where she now spends five days a week helping mothers and soon-to-be mothers get through life living with the disease, says patients simply do not show up at the facilities they are transferred to because being moved to another place for treatment means they risk further exposure to the public.

“There is plenty of shame and fear. Many of the women are too afraid to tell their husbands that they are positive. So they sneak out or lie to come to the hospital to attend counseling meetings and receive treatment. This is easier because it is inside our community but the other Center at Mararaba is farther away, you spend the whole day there. How do they explain that to their husbands?” Alkali says.

With PMTCT services the likelihood of an HIV positive mother passing on the virus to her baby is said to drop from 40 percent to 2 percent.

While the patients blame the sponsors of the PMTCT programme for this policy and the resultant consequences, Patrick Dakum Chief Executive Officer (CEO) of the Institute of Human Virology Nigeria (IHVN), the entity that manages the PMTCT programme on behalf of PEPFAR, says the referral practice is actually based on an existing structure within the country’s health system.

He noted that the institute is aware of the negative impact of the policy, admitting the number of women lost through that process was a source of concern.

“We refer the patients mainly for their own safety,” Dakum explains, noting that most rural health care facilities in Nigeria, like the clinic at Masaka, cannot provide comprehensive care to patients because they lack adequate capacity in staff and equipments.

He adds, “That is not to say we are not addressing the issue of the concerns of women at that level because we lose women because of that. So working with the ministry of health we have come up with a programme called the HIV-AIDs decentralization programme.” Dakum says the idea is to disperse patient care from the secondary health facilities to the primary health care facilities, “but we must first build the capacity of the staff at the primary health centers.”

According to the latest United Nation’s (UN) report, Nigeria currently has the highest burden of Mother-to-Child-Transmission (MTCT) - also known as vertical transmission, of HIV in the world. Last year alone, an estimated 60,000 Nigerian children were infected with the virus - which is about 21 percent of new infections in children globally.

While the head of Nigeria’s National Agency for the Control of AIDS (NACA) Professor John Idoko, blames poor implementation of PMTCT programme in the country for the continued high rate of infant infection, experts say based on known figures the Nigerian authorities are just not doing enough to deal with the problem.

Less than 20 percent of pregnant Nigerian women have access to PMTCT services and out of the grossly inadequate 1,410 PMTCT sites the government authorities say exists across various health facilities in the country, PEPFAR claims to have provided 1,355 of them.

An estimated 230,000 positive pregnant women need PMTCT every year, "as a country, that has been a massive challenge; we've really not been performing close to that,” notes Jerry Gwamma of the Centre for Global Health Nigeria says.

So with such huge gaps in implementation, it is all the more important to eliminate any factors that cause women to slip between the cracks and miss out on interventions like the PMTCT that help stop the spread of HIV in the country.