ince 1986 when the first case of HIV was reported in Nigeria through a 13-year-old commercial sex worker, giant strides have been made to tackle the deadly disease especially in the areas of diagnosis, availability and uptake of HIV drugs.
Nigeria records the second-highest epidemic of HIV globally, and by 2018, there were approximately 1.9 million people living with HIV in Nigeria.
Of this data, 58% were recorded as females, stemming from the deep roots of gender inequality in all facets of the Nigerian society including; culture, religion, economic power, and even in the law. It is estimated that over 200,000 children in Nigeria are living with HIV and 95% of these, results of mother to child transmission (MTCT).
Nigerians typically practice poor health-seeking behaviour substituting unorthodox centres for health centres in resolving both simple and serious ailments. Pregnant women are not excluded from this problem: approximately 65% of pregnant women attend formal antenatal care during pregnancy, highlighting the lack of priority placed on wellbeing during pregnancy.
It should be noted that antenatal care is of an important entry point for counselling and treatment of HIV, as well as partner-testing in positive clients, prevention of mother-to-child transmission of HIV, and opportunity for early infant diagnosis and treatment.
Infants who acquire HIV infection from their mothers do so during pregnancy, labour, delivery or after birth through breastfeeding. Certain factors are associated with an increased MTCT of HIV including severe immunosuppression, new HIV infections during pregnancy or breastfeeding, (because of the surge in viral load associated with new infection), non-usage of HIV drugs in both mother and infant, inappropriate Infant feeding habits/methods, and unsafe delivery practices.
Consequently, there are four prongs in reducing the rate of mother to child transmission of HIV:
Primary Prevention of HIV Infection in Women and Young Girls
By educating the girl-child, and providing them early-on with useful information pertaining to abstinence or sex education, this proven strategy will work effectively in delaying their sexual debut.
Additionally, these girls will be empowered to make safe sexual and reproductive health choices like condom use, avoidance of multiple sexual partners, and voluntary counselling and testing for HIV.
Prevention of Unwanted / Unintended Pregnancies
By practising contraceptive counselling and usage, with an emphasis on dual protection from both pregnancies, and STI/HIV positive partners who are managed by the usage of barrier methods of contraception recommended by a certified health practitioner.
Preventing Transmission from Infected Mothers to their Infants. Transmission of HIV can be prevented by advocating for increased enrollment into formal antenatal care, voluntary counselling and testing for HIV, partner notification and testing, safe sexual practices during pregnancy, infant feeding options and counselling, appropriate and safe delivery options including caesarean section. Other strategies include management of pregnant women with HIV which include the life-long use of antiretroviral drugs, infant antiretroviral prophylaxis, prevention of opportunistic infections like malaria, tuberculosis and pneumonia during pregnancy and nutritional education and support.
Infant feeding is an important element of prevention of mother-to-child transmission as lack of breastfeeding increases the risk of malnutrition, other infectious diseases and death.
With the currently available technology, mother-to-child transmission from breastfeeding is highly preventable through the provision of antiretroviral drugs to the mother and her infant. The effectiveness of ARVs in reducing HIV transmission, in conjunction with the known benefits of breastfeeding in reducing mortality from other causes, justifies an approach that strongly recommends exclusive breastfeeding with ARV cover as the strategy that is the most likely to give infant born to mothers known to be HIV infected the greatest chance of survival. It is worthy of note that a HIV-infected mother must be virally suppressed and must stick to exclusive breastfeeding. If the mother considers exclusive breastfeeding too cumbersome, she may practice formula feeding and must not mix breastfeeding with formula feeding. This is because formula feeding causes micro-inflammatory injuries on the walls of the intestine (as they are foreign) so that breastfeeding exposes the infant to the virus.
Providing Care and Support to HIV-infected Women, their Infants, and Families
HIV-infected women, their infants and families should be enrolled in care programs, and offered antiretroviral therapy and other forms of care as required. HIV infection has been reported to have little effect on pregnancy outcome or complications in the developed world largely due to higher socio-economic factors.
On the contrary, in developing countries such as Nigeria, adverse pregnancy outcomes have been reported in a number of studies, including complications of early pregnancy like miscarriages and ectopic pregnancies, and late pregnancy complications like preterm delivery, still birth, poor fetal growth, and infectious complications like bacterial pneumonia, urinary tract infection and post-operative infectious morbidity. These adverse outcomes have been reported to be either as a direct result of the HIV infection itself, or indirectly from drug therapy and general increased susceptibility to infections associated with the disease, and lower socioeconomic status in developing countries.
There are lots of myths and misconceptions about how HIV is managed such as ingestion of bitter kola, drinking cow urine and various other experimental substances. There is no cure yet for HIV, but antiretroviral treatment works and will keep someone living with HIV healthy. Note that HIV can only be acquired through exposure to bodily fluids like blood, semen, vaginal fluid, anal mucus and breast milk. You cannot get HIV from kissing, hugging, insect bite, toilet seats, sweat, sneezing and coughing.
In conclusion, to reduce the high statistics associated with HIV infections in pregnancy in our environment, there is need for a strong political will by the government to ensure that more antenatal care centers including private and rural health care facilities, are upgraded to provide prevention of mother to child transmission interventions as this will go a long way in tackling the problem of stigma and discrimination.
Incentives can also be provided for HIV positive pregnant women such as free delivery services and linkage to other components of reproductive health in general. Increased funding and partnership with foreign countries and organizations also, cannot be overemphasized.
Dr. Emeka Onuorah is a specialist medical Doctor in Obstetrics and Gynaecology, with interests in reproductive endocrinology, infertility and feto-maternal medicine. He attended the Nigerian Military School in Zaria, Kaduna state and has a thirteen year military service record. He had his undergraduate medical training at the University College Hospital, Ibadan, and postgraduate specialist training at the Lagos State University Teaching Hospital. He is a member of the Society of Gynaecology and Obstetrics of Nigeria (SOGON). He is the Medical Director at JMC Health Care, Consultant at the Nigerian Navy Reference Hospital, Lagos, and visiting consultant to several Private Hospitals. He has been privileged to witness some very important transitions in women’s lives and has a wealth of experience in their reproductive life.