A consultant public health physician, Dr Adegboyega Oyefabi, has called on public health stakeholders to make significant efforts to stop new HIV infections among women of reproductive age group and children.
Oyefabi made the call in an interview with the News Agency of Nigeria on the challenge of HIV/AIDS, which has now been pushed to the background due to global outbreak of COVID-19 pandemic.
He described the transmission of “HIV from the mother to a child as Mother-to-Child Transmission of HIV infection (MTCT)’’.
According to him, this can occur during pregnancy, labour and delivery or breast-feeding.
“If there is no HIV counselling, testing and initiation of appropriate treatment for an HIV infected mother, the risk of mother-to-child transmission is between 25 and 40 per cent.
“Most children, less than 15 years, who are living with HIV, acquired the infection through the Mother-to-Child transmission (MTCT).
“This high burden of MTCT in Nigeria has been attributed to high rate of heterosexual transmission, high prevalence of HIV among women within the reproductive age (15-49 years), and high birth rate.
“Heterosexuality is romantic attraction, sexual attraction or sexual behaviour between persons of the opposite sex or gender.
“Poor antenatal clinic attendance, child delivery at home and in other situations where adequate preventive measures for HIV and other infections cannot be guaranteed.
“Poor breastfeeding practices and harmful cultural practices, including prolonged breast feeding.
“The comprehensive approach to primary prevention of maternal to child transmission of HIV involves four globally acceptable standard approaches.’’
Oyefabi listed them as primary prevention of HIV infection in women of reproductive age and their partners.
“Prevention of unintended pregnancies among HIV positive women; prevention of HIV transmission from infected mothers to their infants.
“Provision of appropriate treatment, care and support to HIV-infected mothers, theirs and family infants,’’ he said.
On primary prevention of HIV infection in women of reproductive age and their partners, he said that all health stakeholders, parents, religious and community leaders should work together.
According to him, this is to reduce the prevalence of HIV in Nigeria, using the ABC approach to enhance safer and responsible sexual behaviour and practices.
“It covers delaying the onset of sexual activity until marriage; practicing abstinence; reducing the number of sexual partners; consistent and correct use of condoms.’’
On provision of early diagnosis and treatment of sexually transmitted infection, the expert said people should seek for early treatment if they notice any sexually related infection.
“For example, sores or bumps on the genitals or in the oral or rectal area, painful or burning urination, unusual or odd-smelling vaginal discharge, penile discharge, unusual vaginal bleeding and pain during sexual intercourse.
“The early diagnosis and treatment of sexually transmitted infection can reduce the incidence of HIV in the general population by about 40 per cent.
“HIV testing and counselling services need to be made available to all women of child-bearing age, because PMTCT interventions depend on the woman knowing her HIV status.
Oyefabi said that the NAIIS 2018 showed steady progress on increasing access to treatment for people living with HIV, with the adoption of a test and treat policy of 2016 in the country.
“This measure has accelerated referrals to treatment facilities for people who tested positive for the virus with more people getting tested and treatment for HIV infection.
“Healthcare provider should initiate the HIV testing and counselling, which is known as Provider initiated Testing and Counselling (PITC).
“Pregnant women should request for this service during ante-natal clinic when the PITC was not done.
“Couple counselling should also be promoted by the healthcare providers to address the challenges associated with disclosure of HIV status, and to reduce HIV transmission from one partner to the other.
“This is to enable couple to take appropriate decisions about sexual behaviour and act on those decisions and to create supportive environment for children in the home that may require HIV counselling and testing.
“Healthcare workers should endeavour to provide appropriate counselling for women who are HIV negative.’’
He said that counselling provides an opportunity for a woman, who is HIV negative, to better understand how to protect herself and her infant from HIV infection.
“It can also serve as powerful motivation to adopt safer sex practices, encourage partner testing and discuss family planning.
“School authorities, in collaboration with the Parent Teacher Association, should organise school-based sex education and counselling for their students, especially for the adolescent boys and girls.
“On prevention of unintended pregnancies among HIV positive, women need to know that they can give birth to their children without them being infected with HIV.
“This is where early diagnosis and treatment is very important, and this emphasises the need for HIV counselling and testing before marriage and during pregnancy.
“Comprehensive information and education about the risks associated with child bearing, as part of routine public health information about HIV and AIDS, are available at many HIV/STI treatment centres in the country.
“This is to ensure that HIV positive women and their partners have informed choices of action, and to respect and support the decisions they reach concerning pregnancy and childbirth,’’ Oyefabi said.
The expert said available services at the hospital facilities where HIV services were being offered should include: providing good quality, user-friendly, and easily accessible family planning services.
He said that this would enable the HIV positive women to avoid pregnancy, if they choose to.
Oyefabi called for promotion of use of condoms (male/female), combined with a more effective method of contraception (dual method) for dual protection from HIV and other sexually transmitted infection and from unplanned pregnancies.
According to him, other effective strategies to prevent HIV transmission, include integrating dual protection messages into family planning counselling services.
“Prevention of HIV transmission from infected mothers to their infants including HIV testing and counselling, HIV and Infant feeding counselling, and use of appropriate method for child delivery to prevent HIV transmission.
“The use of anti-retroviral drugs as prescribed by the managing physicians.
“There is also necessary need for both the healthcare provider, the family and community to provide appropriate treatment, care and support to HIV-infected mothers, their infants and family.
“This will include appropriate anti-retroviral treatment, screening for tuberculosis, continued infant feeding counselling and support.
“Nutritional counselling and support, sexual and reproductive health services, including family planning, cervical cancer screening (PAP smear), psychosocial support and partner counselling and testing.
“There should also be prophylaxis and routine immunisation and growth monitoring and support for the HIV exposed infants.