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HIV/AIDS: Elimination of mother-to-child transmission still challenged

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MOST pregnant women and nursing mothers living with HIV, know that they have to take their antiretroviral (ARV) drugs at regular intervals, and attend clinic, in order to stay healthy and avoid infecting their babies with the virus.

This is part of the new World Health Organisation (WHO) guideline-Option B+, released in September 2015, for elimination of Mother-To-Child-Transmission (eMTCT) of HIV.

The guideline recommends that lifelong ART be provided to all pregnant and breastfeeding women living with HIV, regardless of their CD4 count. It also stresses the need for maintaining continuous adherence to antiretroviral medicines in order to ensure their efficacy.

With good adherence, the viral load among sufferers is suppressed to undetectable levels, reducing onward transmission to the baby and restoring the mother’s immune system for better health.

Unfortunately, investigations reveal that many pregnant women gradually stop taking their medicines after they have been diagnosed with the disease, thereby increasing the risk of transmission during pregnancy, and putting their babies health at risk.

Beside this revelation, some affected women also bared their minds on circumstances that prevent them from adhering to treatment, in their interaction with members of the Journalists Alliance for Prevention of Mother-To-Child Transmission of HIV in Nigeria (JAPiN), who were on a recent visit to the Heart2Heart Centre of Badagry General Hospital (BGH).

For instance, 29-year-old Chika Simon, a resident of Badagry, who is eight-month pregnant complained that, “sometimes, I sleep past my dose time and I forget to take my pills. This usually happens when I am very tired. Usually, my husband is not concerned whether I take my drugs or not, he doesn’t bother to remind me.”

Simon, who takes treatment at BGH, also frequently misses her clinic appointments due to the long distance from her house to the hospital.

“Before I get to the general hospital, I board about four buses and spend more than two hours on the road. It’s always very tiresome getting there,” she told The Guardian.

Because of the long distance, I had to register for antenatal at a private clinic near my house. After delivery, I may be bringing the baby here for treatment.”

Although Chika’s husband is HIV negative, Chika said she got infected while trying to deliver her first child at a private maternity home. Sadly, the baby turned out to be still born.

Victoria Adekunle, who is also pregnant and living with HIV is challenged on two major fronts, when it comes to attending clinic and taking her drugs.

Hear her: “I find it difficult coming regularly to the clinic when I don’t have transport fare. I am challenged financially because I stopped working since I got pregnant.”

“At home because I live with my in-laws, I don’t want them to notice when I am taking my antiretroviral drugs so when they are around, I will not take my drugs,” added Adekunle, who is six-month pregnant.

Like Simon, Adekunle claims she got infected with the virus through blood transfusion at a private hospital, where her former employer had on retainership, in 2010.

“This is my first pregnancy since I became positive, and my new husband knows about my status, and he is HIV negative, but his family does not know,” she said.

Because of fear stigmatisation and rejection, Mrs. Adekunle said she often fail to take her drugs when she is with people. “This makes my viral load increase sometimes.”

These instances present only a minute picture of factors that thwart the war against mother-to-child transmission.

However, a psychosocial counsellor, with the Centre for Positive Health Organisation, Lagos State (Eko-CEPO) Support Group, under the platform of Abidjan–Lagos–Corridor, Salami Bukola, said her organisation has been working tirelessly to ensure that the people living with HIV/AIDS (PLWHA), adhere to their treatment and attend clinic.

“We monitor and follow-up PLWA; counsel them to accept their result and register to receive ARV drugs. We don’t force the PLWA, rather we tell them the negative impact of not registering and adhering to the prescription of the ARV. Most of them forget their clinic days, and may not know how to go about their pregnancy because of their positive condition, so we put them through.”

Bukola continued: “We tell them the benefits of the drugs they are taking, and we ensure that they give birth to babies that are HIV free.”

The counsellor added that the group even goes as far as calling and visiting homes of affected persons, when they refuse to attend clinic. “We beg them, entertain them and play with them, but they always complain that they don’t like the way some counsellors talk to them. During meetings, we provide N1, 490 for their transportation and provide feeding”, she explained.

The Challenge Of Accessing ARV Treatment
ALTHOUGH ARV treatment is free at many centres, the cost of some laboratory tests is a deterrent for some PLHA, who are financially handicapped.

Insisting that funding is really a big challenge to PLHA Salami said, “Government and other organisations need to come in and help these people by funding the programmes. Also, there is need to increase awareness against stigmamatisation. 

An Associate Professor and Consultant Haematologist at the Lagos State University Teaching Hospital (LASUTH), Akinsegun Akinbami, while commenting on this development said, “Initiatially everything was free until donors started withdrawing their services, but now, consultation is free, medication is free, but the lab test is not completely free. The full blood count, urea critenun, liver tests, hepatitis, are not free. Patients pay up to N4, 000 when they want to enroll, but we sometimes give waiver to patients, who cannot pay. Every six months, they repeat their CD4 count and viral load for N2, 000.

“For HIV positive persons, undergoing laboratory tests before treatment is mandatory, so we can determine the kind of treatment suitable for them. Some patients may have a condition that makes the drug unsuitable for them, which is why tests are necessary,” he explained

Still speaking on the imperative of removing obstacles that stop sufferers from accessing treatment, Executive Director, Centre for Positive Health Organisation, Lagos State, which is also under the platform of Abidjan–Lagos–Corridor, Mrs. Kadiri Oluseyi, said there is need to eliminate the stigmatisation of People Living With HIV/AIDS, in line with the global campaign for safer motherhood and HIV-free babies.

According to her, support from the government, through increased funding and access to ARV drugs will help to ameliorate the challenges of PLWHA, especially pregnant mothers, and help in the elimination of Mother-To- Child- Transmission (eMTCT).

“PLWHA are faced with a lot of discrimination. For instance, a lady came to us and complained that she was sacked from work because she is HIV positive. So, government should put more efforts in addressing stigmatisation. There should be intensive education on eliminating discrimination against PLWHA.”

Shedding light on the Abidjan-Lagos-Corridor Organisation, she said it is a HIV support group that is working in partnership with the Badagry General Hospital antenatal unit.

“Our focus is that information reaches every individual about HIV counselling, testing, and treatment. We also provide access, care and support especially to those that have tested positive. We believe that all those that have tested HIV positive must be treated with equal right; we stand for justice. Some of the difficulties we face are that most of the PLWHA are always upset, not owning up to their status, or visiting the hospital in line with the directive of their psychosocial counsellors. Some of them often refuse to be counselled or receive drugs. However, we don’t give up; we still counsel them on the risk involved in their action, both on their health and on the community. With persistent information, they often succumb.

“Getting infected is one thing and accepting the result is another. Taking it upon one’s self to live a positive life is also another thing. So, affected persons need to accept that they are positive. Secondly, they need to get access to treatment. By the time they are beginning to access treatment and now fully in charge of themselves, knowing that they have to remain on treatment and live a positive life to avoid getting fresh infections, or getting other people infected, definitely, the information we are giving out would have become valuable,” the executive director said.


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