As Nigeria joined the world to mark the 2021 World AIDS Day, PUNCH HealthWise spoke with some mothers who got to know their HIV-positive status during antenatal care.
World AIDS Day, marked on December 1 every year since 1988 is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. It is also to honour those who have fallen to the disease and people living with HIV.
The theme of World AIDS Day 2021 is ‘End inequalities, End AIDS’, which seeks to highlight the growing inequalities in access to essential HIV services.
In commemoration of this year’s World AIDS Day, the WHO, on December 1, called on global leaders and citizens to confront the inequalities that drive AIDS and rally to reach people who are currently not receiving essential HIV services.
They share their experiences on the trauma and fear they had to deal with during pregnancy and their excitement when they gave birth to HIV-negative babies after they were placed on treatment.
Mary cried her heart out on December 31, 2018, when she tested positive for the human immunodeficiency virus (HIV). She was five months pregnant with her second child and her HIV-positive result devastated her. She was screened by the health workers during her antenatal care and when her test result came out positive for HIV, her mind was in turmoil.
The entrepreneur who left the hospital in tears was particularly troubled about how to break the news to her husband.
The 24-year-old mom-of-4 who got married in 2016 could not figure out how she was infected with the deadly virus as she tested negative all through her antenatal care visits when she gave birth to her first child in a government-owned hospital in 2017.
Based on the advice and encouragement of the doctor, Mary, however, summoned courage when she got home and told her husband in tears that she is HIV positive. She was extremely afraid that her husband would send her away after hearing the news.
But that didn’t happen as she was surprised that her husband received the news calmly and told her that contracting HIV was not the end of life.
While she was consoled by her husband’s response, she was hopeful that her confirmatory test would be negative. She was, however, also worried about her husband’s status.
The fair complexion woman said she got the shock of her life and became traumatised when her confirmatory test returned positive and her husband tested negative for the virus after he ran his test.
I became HIV positive after my first delivery –mother of four
Sharing her experience further, Mary who has given birth to three HIV-negative babies since she contracted the infection says she never knew she could still have HIV-negative babies afterward. She narrated further:
“I found out I was HIV positive on December 31, 2018, during my antenatal care (ANC). I was five months pregnant with my second child when I registered for ANC and was asked to run an ANC profile. During the profile, the health workers checked my blood group, genotype, and HIV status.
So, when the result of the HIV screening came out, it was positive. That was how I discovered that I am HIV positive. When the health workers broke the news to me and gave me my result, the next thing on my mind was suicide.
I was crying bitterly that I was going to take my life. But one of the doctors that saw the way I was crying and shaking my head counselled me. He took time to talk to me and assured me that contracting HIV is not a death sentence provided I am on treatment and religiously take my drugs.
He assured me that if I take my medication as advised I will deliver an HIV-negative baby. He suggested I go for a confirmatory test, noting that if the result returns positive I will be placed in a facility where I can access Prevention of Mother-To-Child Transmission services.”
Marry went on,
“Though I was somehow relieved after the counselling, my concern was how to break the news to my husband and what would become of my marriage.
“When he returned from his business that day, I started crying and he asked if somebody died. When he became so disturbed about what could make me cry uncontrollably, I summoned courage and broke the news to him. After which I told him I was going to kill myself because I couldn’t explain how I was infected though deep in my heart I was suspecting I got it from him.
“But I was surprised my husband received the news with calmness and told me that contracting HIV is not a death sentence.
He asked me to go for a confirmatory test as the doctor suggested before I jump to a conclusion. His response gave me hope. But I was shocked to the marrow and devastated when my husband tested negative to the virus when he had his test done and my confirmatory test returned positive.”
Continuing, she said,
“I was however lucky to get my husband’s support despite his status and I was placed in a PMTCT facility for treatment in order not to infect my baby.
“So, at PMTCT clinic, I was given antiretroviral treatment and counselled how to be regular with my drugs in order not to infect my baby. The important thing according to physicians at the facility is to take my drugs properly as prescribed and I did.
“And to the glory of God, I gave birth to an HIV-negative baby in 2019. I am excited to say that I have given birth to three HIV-negative babies vaginally since I was infected. Necessary and confirmatory tests have been carried out on them and they all tested negative. The status of my children excites me despite living with the virus.”
On the issue of breastfeeding, she said, “I breastfed them for six months after which I introduced infant formula.”
ANC helps to detect HIV-positive mothers
A medical researcher, Dr. Dan Onwujekwe says HIV can be transmitted from an infected mother to her child during pregnancy, childbirth and breastfeeding if she is not on treatment.
Onwujekwe, a retired Chief Research Fellow at the Nigerian Institute of Medical Research, Yaba Lagos, said that it is also compulsory to test all pregnant women for HIV when they come to an antenatal clinic, stressing that it helps in the prevention of motor-to-child transmission of HIV. He said:
“If we can provide antenatal care to every pregnant woman and during the antenatal care we offer them HIV testing, we would be able to detect those who are HIV positive and put them on treatment.
“And if they are treated three to six months before they deliver, it is likely they will not transmit HIV infection to their babies.
“But we have so many babies being born with HIV in Nigeria because their mothers were not tested during pregnancy.
“If pregnant women access antenatal care, those who are HIV positive would be discovered during screening and would be placed on treatment.”
According to a 2019 report by the United Nations Children’s Fund, in Nigeria alone, about 22,000 new HIV infections occurred in children aged 0-14 years in 2019.
How I gave birth to four HIV negative babies –38-year-old HIV-positive mother
Another HIV-positive mother who succeeded in giving birth to four boys without infecting any of them after undergoing treatment is 38-year-old Precious.
The businesswoman narrated,
“I got married in 2009. So, in 2010 when I became pregnant, I went for my ANC when I was only two months pregnant. It was my first pregnancy.
“After my registration, I was asked by the doctor to run some tests including an HIV test. When the result of the HIV test came out, I tested positive for HIV. That was how I got to know that I am HIV positive. I was told to bring my husband to run the test which he did and his result was negative.
“The doctor asked me to do a confirmatory test and the result was still positive. I couldn’t figure out how I was infected.”
Asked if she knew her HIV status before she got married, Precious said,
“To be frank, I didn’t know. And my husband and I did not do HIV screening before we got married because we dated for seven years before we tied the knot.”
On how she successfully gave birth to four HIV-negative babies, she recounted,
“I was lucky I got my husband’s support. Though it wasn’t easy for me to move on when my husband tested negative because I thought I got it from him.
“I wanted to take my life because I couldn’t figure out how I was infected. When my husband saw that I was serious about taking my life based on some moves I was making then, he stopped work for a while to monitor me. He didn’t allow me to stay alone anymore. This went on for over a month because I thought I was going to have an HIV-positive baby which will be another burden to me.
“When I came out of the trauma, I went back to the doctor and he counselled me. He told me to immediately commence treatment. He assured me that if I could take my anti-retroviral drugs as instructed that I would live healthily and also have an HIV-negative baby.
“I heeded his advice and at the end gave birth to an HIV-negative baby in October 2010. I followed all the instructions given to me at the Prevention of Mother-to-Child Transmission of HIV (PMTCT) clinic and took my drugs as instructed. That was how I was able to give birth to four HIV-negative boys through a caesarean section.
“My first child is now in secondary school. I am happy that the virus did not deny me the joy of motherhood.”
Testing HIV positive two weeks to my delivery traumatising
For Bisi, a 35-year-old mother, testing positive for HIV two weeks to her delivery during her second pregnancy, was a bitter pill to swallow. The housewife narrated:
“I had my first baby in 2016 after my wedding the previous year. I attended ANC and did all the necessary tests. I also did HIV test and everything was fine.
In 2018, when I became pregnant with the second baby, I registered for ANC when I was three months gone and was regular with my appointment. I did HIV screening during the registration and the result was negative.
But two weeks before my delivery, I was asked to do an HIV test and surprisingly, the result came out positive. My husband, however, tested negative. I suspected I contracted it in a salon. So, I was given treatment and the baby tested negative for HIV when I gave birth to him.
I have been on treatment since then and in 2020, I was still able to give birth to another HIV-negative baby despite my status.”
Other HIV-positive nursing mothers who spoke with PUNCH shared similar experiences of how they gave birth to HIV-negative babies despite their status.
According to the American College of Obstetricians and Gynaecologists, babies who are born to HIV-positive mothers are supposed to be tested for HIV several times in the first few months.
“The test looks for the presence of the virus in the baby’s blood. The baby has HIV infection if two of these test results are positive.
The baby does not have HIV infection if two of these test results are negative. Another type of HIV test is done when the baby is 12–18 months old,”
Newborn babies account for at least 22 per cent of new HIV infections in Nigeria –NACA
The latest report by the National Agency for the Control of AIDS titled, ‘Estimating modes of HIV transmission in Nigeria’ launched in August 2021, shows that newborn babies account for at least 22 per cent of new HIV infections in Nigeria
The report reads in part,
“New child infections due to mother-to-child transmission represent the second source of new infections accounting for 22 per cent of all new infections. In many states, the contribution is even larger.”
The report added that the PMTCT programme, which could stop HIV-positive pregnant women from passing the virus to their offspring, had not been as effective as it should be because only 50 to 60 per cent of pregnant women get antenatal care.
“The second-largest source of new HIV infections is newborns. Coverage of PMTCT is low due to low rates of antenatal attendance. Efforts are needed to encourage women to attend ANC especially in high prevalence states,”
the report noted.
HIV pregnant women must be placed on treatment –Experts
Continuing, Onwujekwe blamed the burden of children living with HIV in Nigeria on poor HIV testing of pregnant women during ANC.
The researcher further explained, “We have a very high number of paediatric HIV, that is, children born with HIV. This shows that their mothers were not tested in pregnancy.
“That means they were not accessing antenatal care because if they were accessing antenatal care, the mothers would have been discovered and they would have been placed on treatment.
“We still have a lot of work to do since we still have a lot of paediatric HIV cases. The big challenge is to identify these babies who are likely to be born with HIV infection before they are born.”
The health expert also decried the lack of personnel adequately trained to deliver HIV services.
He called for the training of traditional birth attendants in HIV management, adding that pregnant women patronising them should have access to HIV testing to further prevent mother-to-child transmission of HIV. He added:
“We need to have a mobile HIV monitoring and management team that can reach many TBAs and communities to deliver these services. They should be properly remunerated. If we can do that, no child will be born with HIV in Nigeria. And that is a window of opportunity we must try to invest in.”
Another medical expert, Dr. Olugbenga Ijaodola, says HIV-positive pregnant women must be placed on HIV treatment and encouraged to deliver in health facilities to reduce the burden of mother-to-child transmission of the infection.
Ijaodola who is an Assistant Director, National Prevention of Mother-To-Child Transmission at the Federal Ministry of Health said, “This will ensure that HIV positive babies are identified on time and treated”.
The assistant director who leads the PMTCT team at the National AIDS and STIs Control Programme, said many babies are born HIV positive because their mothers had no access to care and were not on treatment before the babies were born. He said:
“HIV/AIDS intervention cannot stand on its own, it needs the collaboration of every implementing partner. So irrespective of challenges in our health system, we say pregnant women must have access to testing and those who turn out positive must be placed on treatment and encouraged to deliver in health facilities for early infant diagnosis services.”
According to the World Health Organisation, testing and counselling for HIV should be considered a routine component of the package of care for pregnant women in all antenatal care settings.
Testing during ANC helps prevent mother-to-child transmission of HIV –WHO
The global health body stressed that testing during ANC helps in the prevention of mother-to-child transmission of HIV.
It says the availability of HIV testing at ANC services is responsible for the high level of knowledge of HIV status among women in many countries. This, WHO said, has allowed women and infants to benefit from ART.
“WHO recommends that ART should be initiated in all pregnant women diagnosed with HIV.
“This recommendation is based on evidence that shows that providing ART to all pregnant and breastfeeding women living with HIV improves individual health outcomes, prevents mother-to-child transmission of HIV, and prevents horizontal transmission of HIV from the mother to an uninfected sexual partner,”
the global health body said.