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•Rising cases of HIV+ children endanger homes, marriages
From Fred Ezeh, Abuja
There’s growing silent fight and quarrel in Nigerian homes and families, even as marriages are also being threatened as a result of increasing numbers of children testing positive to HIV and Tuberculosis (TB).
The development has, unexpectedly, thrown up deep suspicion among couples on who could have infected the children with such “deadly” diseases or how they contracted them, even when some of the parents are unaware of their HIV status.
Stakeholders involved in HIV response in Nigeria are also concerned, hence they are afraid that such development could affect the chances of Nigeria meeting the global target of epidemic control of HIV/AIDS by 2030.
To this end, they advocated rapid change to case finding, Early Infant Diagnosis (EID), Prevention from Mother-to-Child Transmission (PMTCT), treatment and most importantly, managing family crises that could arise thereafter.
In the cause of enquiries, Daily Sun realised that many of the HIV-positive children might have contracted the virus through their parent(s) or third party, and had kept status secret from the children, while they subject them to daily consumption of drugs that would, expectedly, suppress or maintain the already suppressed viral load.
In the beginning
Pre-marital tests, notably, HIV/AIDS, Hepatitis B and C, and several others, being a prerequisite for marriages, is often used to ascertain the health status of couples before they join together.
Both churches and mosques seem to have made it compulsory for couples to present test results from certified laboratories indicating that they are free of hepatitis B and C, HIV and that their genotype is compatible.
These tests are carefully conducted to ensure the couples are safe, and their offspring are free of deadly diseases that might affect their life and living. Unfortunately, these tests are never repeated despite several dangerous exposures after marriage.
But research revealed that many couples indulge in secret risky behaviours and relationships which often expose them to sexually transmitted diseases, notably, HIV, hepatitis, among others. Unknowingly or otherwise, they contract these diseases, and begin to distribute them to family members and other people they might come across until random tests that might reveal their true health situation.
What happens thereafter is that they sneak out, individually, to health care centres, refill their containers with HIV drugs, hide it from each other, and take it when, perhaps, the ‘coast is clear’ to do that. This they continue to do until their secret is revealed.”
Expected consequences
A Consultant Pediatrician from University of Port Harcourt Teaching Hospital (UPTH), Dr. Rosemary Ugwu, in her submissions indicated that the issue is a big challenge that is causing a huge silent crisis in families, and in many cases, result in breakdown of homes and marriages.
She said: “Many silent crises and disconnects in several homes and marriages could be traced to such things, but oftentimes, people from outside won’t know. In the course of my professional duties over the years, I have seen and handled several pediatric HIV and TB cases some of which were suddenly discovered in a child(ren) of a particular family.
“I have had several experiences handling such and other related cases in adults. Some are complicated because the children present HIV and TB at the same time which were not in them during or after birth, neither was it in the lineage of their parents. Undoubtedly, these ailments are deadly and attract discrimination and stigmatization, hence no one wants to associate or diagnose it.
“Nevertheless, when such a situation presents itself, we begin with the treatment of TB which is curable before administering HIV drugs. Sadly, such discoveries often throw families ‘off the balance,’ particularly if both parents tested negative to such diseases during pre-marital tests, or in situations where there was suspicion of a parent being involved in extra-marital affairs.
Suggested approach
Ugwu, advocated the adoption of a family-centred approach to preventing and managing family crises that might arise from sudden record of pediatric HIV or TB cases.
In addition to that, she confirmed that handling the case of HIV-positive children is delicate and sensitive, hence some special skills and competences are required. “This issue has resulted in silent crises in homes and breaking of marriages in cases that were not carefully handled.”
She insisted that HIV-free generation is possible if there could be openness and sincerity among couples, as well as support for each other, particularly from family members to children and young adolescents who are infected with the virus.
“These children should be adequately educated when curiosity sets in as they grow in age and knowledge. But unfortunately, the reverse is often the case. They are kept in the dark. Rather, they are put on daily consumption of antiretroviral drugs by their parent(s) without them having adequate information on what the drug does.
“When these children take these drugs for months or years, they become uncomfortable at a point and curiosity sets in. They would begin to ask several questions and act unfriendly to their parent(s) because of forceful consumption of drugs that they knew nothing about, meanwhile, they have been in the dark for several months or years.
“In some point, blackmail could be introduced by the children. Some would insist on getting something like phones, iPad, monetary rewards or something else from their parents before they could take the drugs without knowing that the drugs are saving their lives. Some of the children, out of curiosity, could decide to input the name of the drug on Google or other search engines, to research about the drug on what they do to the body.
“The worst case scenario is when parents would deliberately refuse to disclose their status to each other. Meanwhile, one or both of them might have tested positive to HIV, and are on drugs or might have obtained viral load suppression. They come, individually, at different times, to get treatment until one day they meet each other in the facility, and the crisis will start.”
She maintained that the only solution is openness to each other, as well as support through the family platform whenever such cases are recorded.
EGPAF intervention
Few days ago, a HIV advocacy group, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), launched a newly developed toolkit that would, expectedly, herald improved quality EID services across health care facilities managing pediatric HIV.
The document contained Standard Operating Procedures (SOPs) for several stages of pediatrics HIV responses, and was recommended for all health care facilities involved in handling pediatric HIV cases.
The Foundation advocated a family-centred approach to tackling the myths and other related issues of HIV/AID among children. It stressed that such an approach has proven to be efficient and effective in responding to pediatric HIV cases, thus giving them a sense of love and belonging as against stigmatization and discrimination.
EGPAF Country Director, Dr. Avese Torbunde, explained that the toolkit was developed based on experiences and activities of the Foundation in Rivers and Taraba States through the EID point of care project supported by Johnson and Johnson and other partners.
She maintained that involvement of family members with unconditional love and care from them would help to neutralize the myth and misconceptions associated with HIV treatment in Nigeria.
She said: “This approach and other measures were adopted in response to pediatric HIV cases in Taraba and River States, where the Foundation carried out several advocacy and response projects.”
NASCAP coordinator
National AIDS and STDs Control Programme (NASCP), Dr. Adebobola Bashorun, said that Nigeria has, undoubtedly, made an early gain as regards the fight against HIV/AIDS in Nigeria.
He, however, said that the situation of pediatric HIV is worrisome, and should be a source of concern for all Nigerians, especially as the country prepares for the global target of ending epidemic control of HIV/AIDS by 2030.
He confirmed that Nigeria is not doing too well regarding HIV coverage among pediatrics, but in terms of national coverage among adults, the country is doing well. “It’s a known fact that the majority of people with HIV are adults. So the pediatric cases among the population need to get more attention, starting with case finding.
He said: “A system called Pediatric and PMTCT Retention Care Programme that focuses on case finding, treatment and strengthening the PMTCT component of the treatment was recently established, and positive results are being expected.
“Base on data, the prevalence among children is 0.1 per cent. For adults, it’s about 1.3 per cent. This is a huge number when compared to our population which is over 200 million. So, the target is 0.0 per cent for children which is achievable through collective effort particularly in case finding and linkage to treatment.
“Having a HIV-free generation is very much possible. The target is to identify every child with the disease, and place them on treatment. But the bigger target is to prevent further transmission to the unborn children through the PMTCT programme. To this end, the EID programme is an effective way of achieving that.”
On possible complacency that could trigger possible rise in infection, Bashorun said, “We don’t foresee that for three reasons. First, most of the funding that comes from partners is to ensure that countries don’t step down their fight against HIV preparatory to the 2030 deadline.
“So, if complacency is noticed in any way among the responders, funding from donor partners could be withdrawn. So, that is not expected from anyone now and people involved in HIV response in Nigeria are very much aware. But nevertheless, more effort would be required to identify the remaining people.
“So, complacency cannot be accepted in the fight against HIV/AIDS. Truly, we are moving closer to epidemic control. But there’s a need for sustenance of the momentum. It’s important that we finish the projects and sustain the gains that have been achieved therein. Our focus should be on sustainability and ownership. But before then, we must close the remaining gaps.”
