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Low account for HIV programmes and government’s abortion to abode stigmatisation of bodies active with HIV/AIDS aid admission in citizenry of babies built-in with the ache in Nigeria, ENIOLA AKINKUOTU reports

The adventure of Mrs. Martina Solomon, perhaps, explains why Nigeria has become the country with the accomplished cardinal of babies built-in with the Human Immuno-deficiency Virus in the world. The 34-year-old, who lives in a one-bedroom accommodation in Mararba, a suburb of Nasarawa Accompaniment inhabited mostly by low assets earners, has absent three accouchement to the disease.

In 2007, abundant with her aboriginal babyish at the age of 24, Mrs. Solomon went to annals for ante-natal affliction at a government hospital area she was diagnosed with HIV. Having witnessed how bodies active with the ache were ostracised in her community, she banned to acquaint alike her bedmate about her status.

Afraid that if she accustomed anti-retroviral drugs her ancestors ability blunder aloft them, she banned to heed medical admonition and abandoned all entreaties by doctors to anon activate the Blockage of Mother-to-child Manual programme, which provides analysis to HIV-positive abundant women as a admeasurement to stop their breed from actuality adulterated with the virus.

Solomon eventually gave bearing to a babyish babe and she called her Favour. Unfortunately, the babyish died of HIV infection at aloof 10 months of age. Still active in denial, the adolescent mother got abundant afresh and was delivered of addition babyish girl, whom she called Kasham. Translated in English from her built-in tongue, it bureau ‘beauty’.

“I had become affected to several diseases by the time I had Kasham. I had tuberculosis and herpes. Kasham additionally died because I had been breastfeeding her,” she recalled in an emotion-laden voice.

“The third babyish was built-in the afterward year, which was 2009. Her name was Rejoice. She died at the age of one month. It was at that point that I came to agreement with my activity and started demography drugs,” she added.

Solomon afterwards opened up to her bedmate about her cachet and anon began demography treatment. Her husband, who is a bartering motorcycle rider, however, activated abrogating to the virus. She has back accustomed bearing to three accouchement who acquire all activated abrogating to HIV.

For Mrs. Joy Nufi, a beautician active in the aforementioned Local Government Area as the Solomons, the adventure is absolutely similar.  She was diagnosed with the cureless ache in 2002.

On accepting home, she abreast her bedmate who told her to abandon the address as he believed it could not be true. Her bedmate additionally banned to get activated and told her to ensure that no one got to apperceive of the diagnosis.

“I banned to booty any drugs because I believed the analysis was amiss and it was not my portion. My bedmate told me not to acquire the doctors. Also, I could not alive with the stigma. I anticipation to myself, what would bodies say,”a apologetic Mrs. Nufi recalled.

When she assuredly gave bearing to her baby, he was diagnosed with HIV and died anon after. Rather than acquire that she was adulterated with the virus and alpha treatment, the beautician got abundant about anon and still banned to use the anti-retroviral analysis assigned by doctors.

“In 2003, I got abundant afresh and the hospital insisted that I acquire HIV. They gave me drugs, but I alone them. I gave bearing to the adolescent and called him Sonny. However, back he was about 15 months old, he died of measles. But I was told that he additionally had HIV,” the beautician recalled.

In 2005, she got abundant for the third time. This time, she absitively to use the casework of a acceptable bearing accessory back accustomed anesthetic and able doctors had bootless her in the past.

The beautician gave bearing to a boy which she called Moses.

She said, “A few months afterwards I gave bearing to Moses at a clandestine home, he fell awfully sick. So, I said to myself that I allegation not lose a third child. I rushed him to a government hospital area he was diagnosed with HIV.

“I cried and begged the doctors not to acquiesce my alone adolescent to die. I told them I was accommodating to do anything. It was at that point that I assuredly accustomed my status. Moses was anon put on drugs, while abundance was delayed a bit because my viral bulk was actual high.”

Nufi accountable her bedmate to get activated and he was additionally diagnosed with HIV and put on treatment. Afterwards demography her drugs religiously, however, and advancement a low viral load, the beautician was able to accord bearing to two altogether advantageous children.

“I had a added adolescent in 2010 – called David – and girl, Manuela, in 2015. I was took drugs as assigned so they came out negative. David is seven while Manuela is two,” she said.

60,000 HIV-positive babies built-in annually

According to a address by the Joint United Nations Programme on HIV and AIDS, 60,000 babies are built-in with the HIV every year in Nigeria. The bureau says the bulk is the accomplished for any country in the world. The bureau additionally identifies mother-to-child manual as the above bureau in which these babies are actuality adulterated with the disease.

The UNAIDS says, “Nigeria has the bigger cardinal of accouchement accepting HIV infection – about 60, 000,  a cardinal that has remained abundantly banausic back 2009. Afterwards an burning activity in Nigeria, the all-around ambition is absurd to be reached. Nigeria accounts for one-third of all new HIV infections amid accouchement in the world, the bigger from any country. Progress actuality is, therefore, analytical to eliminating new HIV infections amid accouchement globally.

“Nearly all indicators adjourned appearance stagnation and advance that the country is adverse cogent hurdles. It charcoal a concern, that admitting several years of interventions, admission to paediatric ART casework continues to hover about the 28 per cent mark for six years running.

“It is appropriately awkward that PMTCT casework are accessible alone to 30 per cent of the abundant citizenry annually. These poor indicators are unacceptable and crave a re-think about our allocation strategies for the ascendancy of HIV/AIDS in Nigeria.”

2.3 actor Nigerians not on treatment

While Mrs. Solomon and Mrs. Nufi acquire affected their fears and are now neighbourhood counsellors, the aforementioned cannot be said of best Nigerians active with HIV.  According to UNAIDS, about 3.2 actor Nigerians are active with HIV, but alone one actor of that citizenry are on treatment.

In 2016, Nigeria had 220, 000 new HIV infections and 160, 000 AIDS-related deaths. Amid abundant women active with HIV, alone 32 per cent were accessing analysis or prophylaxis to anticipate manual of HIV to their children.

While admission to the drugs charcoal a challenge, the Abbot of Health, Prof. Isaac Adewole, says the abstracts can alone be bargain if added Nigerians knew their HIV status. According to the Director-General of the National Bureau for the Control of AIDS, Dr. Sani Aliyu, men acquire banned to appear for HIV testing and may aggregate a ample cardinal of the 2.3 actor Nigerians not on medication.

Stigma stifles hope

One of the bigger factors militating adjoin the success of HIV programmes is the stigma that is associated with the disease.

So far, alone seven states – Kaduna, Nasarawa, Benue, Cross River, Enugu, Ogun and Lagos – out of the 36 states of the federation, acquire promulgated laws adjoin bigotry of bodies active with HIV/AIDS.

According to NACA, the after-effects of stigma and bigotry are absolute and these absolute admission to HIV testing, analysis uptakes and added admission to added HIV services.

The bureau states that HIV-related stigma and bigotry do not alone arrest the affairs to blockage options – for aboriginal apprehension and treatment; it increases vulnerability to acknowledgment and possibly afterlife in best cases of beard of HIV absolute status.

Investigations showed that admitting the HIV AND AIDS (Anti-discrimination) ACT that was active into law in 2014, the accepted behaviour of institutions and individuals appear bodies active with HIV had not bigger significantly.

Section 5(1) of the Act states that no individual, community, institution, employer or agent shall discriminate, anon or indirectly, adjoin any actuality in the association on the base of the person’s HIV cachet or acumen of aforementioned in employment, commitment of casework and added benefits.

The law adds that no actuality shall acknowledge advice apropos to the HIV cachet of addition alone afterwards their accord and no one shall be affected to booty an HIV analysis as a activity for employment

It imposes fines alignment from N250, 000 to N2m on bodies bedevilled for acrimony the law. However, there is no accepted almanac of anyone actuality bedevilled for abrogating the anti-discrimination law.

It was learnt that some administering acquire begin means of circumventing the law by ambitious accepted medical tests as a pre-condition for appliance and end up abstinent HIV-positive candidates job in the process.

“When an employer requests a accepted medical analysis and the claret sample of the -to-be agent is taken, there is no way of alive if an HIV analysis has been conducted on that claret sample. It again becomes difficult for a actuality to prove that he was sacked or denied appliance because of his or her HIV status” says Mrs. Toyin Aderibigbe, the agent for NACA.

She added declared that although best victims did not address cases to NACA, the bureau was consistently accessible to advice individuals who had complaints.

Mrs. Stella Ebe, the Nasarawa Accompaniment Deputy Coordinator, Network of Bodies Active with HIV/AIDS in Nigeria, told our contributor that if the affair of bigotry and stigmatisation was not addressed, it would about be absurd to analysis the advance of the disease.

The NEPWAHN coordinator, who acclimated to advertise akara (fried bean cake) in Maraba, said she shut her business afterwards her HIV cachet became accessible ability and bodies chock-full patronising her.

Ebe, who is HIV absolute but has six accouchement that are HIV-free, said the ache was no best a afterlife book as abounding bodies active with the virus, but took their drugs appropriately, were alive advantageous lives.

The NEPWAHN coordinator, who is now a advocate at the Mararba Guruku Medical Centre, said a jailbait in the association afresh committed suicide because he was stigmatised by his mother.

She added declared that abounding religious organisations banned to conduct marriages for bodies active with HIV.

Ebe said, “Stigma is a big problem. Some bodies don’t appear to the hospital because they are abashed of the bodies that will see them. The law adjoin stigmatisation has been of little effect. I acquire taken several bodies to cloister for stigmatisation, but you apperceive how apathetic the administrative action is in this country.

“There are husbands who bandy out their wives back they acquisition out they are positive. So, how will women accessible up to their partners? Stigma can anticipate bodies from advancing to accept chargeless drugs because they are abashed of actuality apparent by those who apperceive them.

“It additionally prevents bodies from accepting tested. One of our members, Henry Hillary, afresh committed suicide because he was stigmatised by his family. Indeed, abounding bodies with HIV acquire committed suicide in contempo times.

“Even government agencies like the police, the NSCDC and the FRSC do HIV tests for trainees. Three of our associates had scaled every hurdle, but they were abnormally butterfingers afterwards medical tests. Some pastors accelerate their associates to do HIV tests as a activity for marriage.

“Sometimes, back a suitor who is not HIV absolute agrees to ally a accomplice that has HIV, the pastor will abash the actuality or force them to assurance an undertaking. I afresh had to arbitrate in one of such cases afore it was assuredly resolved. Stigma is not reducing.”

Mrs. Elizabeth Aluna, who is the Benue Accompaniment Coordinator, Association of Women Active with HIV and AIDS in Nigeria, said the stigmatisation was alike worse in rural areas with is a aerial akin of benightedness and area everybody knew everyone.

‘Expensive’ ante-natal care

Experts say that addition acumen why HIV/AIDS manual from mother to adolescent has connected to admission amid the poor is the bulk of ante-natal affliction and delivery, which has acquired abounding alert mothers to opt for acceptable bearing associates whose servives are abundant cheaper.

Patronising such unskilled cadre has additionally contributed to authoritative Nigeria the country with the third accomplished baby bloodshed rate, accounting for 10 per cent of new built-in deaths worldwide, says UNICEF.

According to the Apple Health Organisation, afterwards treatment, the likelihood of HIV casual from mother to adolescent is 15 per cent to 45 per cent. However, Anti-Retroviral Analysis and added able Blockage of Mother To Adolescent Analysis interventions can abate this accident to beneath 5 per cent Women who do not go for ante-natal affliction acquire little or no admission to HIV drugs

According to Ebe, abounding poor alert mothers adopt to accord bearing at home because of the bulk of delivery, which is aerial and unaffordable.

She added, “Many Nigerians are poor and not abounding of them can allow ante-natal care. Women activity for ante-natal pay for cards, tests, scanning and added tests. A actuality who is poor will not see the allegation to do all of these. So, if the government can accomplish ante-natal affliction free, abnormally for bodies active with HIV, it will go a continued way to analysis the manual of the ache from mother to child. Some won’t alike register. So, they opt for acceptable bearing attendants.”

Also, Solomon apprenticed governments at all levels to ensure that women, abnormally those active with HIV, are accustomed chargeless ante-natal affliction and are accustomed to acquire chargeless deliveries.

According to her, as continued as acceptable bearing associates allegation beneath than accepted hospitals, it will be difficult to barrier the advance of HIV from mother to child.

For Mrs. Aluna, who is the ASWAHN coordinator in Benue State, one of the means to animate women to absolutely participate in the PMTCT programme is to mobilise their husbands.

She acicular out that one of the affidavit abounding women, abnormally those active in the rural areas, acquire not taken ante-natal affliction actively is because their husbands haven’t encouraged them.

She said, “Most of our bodies are poor. So, back they are pregnant, best of them shy abroad from ante-natal care. Back some do attend, they go to bear at the TBAs. And instead of the TBAs to accredit them to hospitals afterwards delivery, they don’t. Stigmatisation is still a austere issue, abnormally in the villages. I acquire these are the accessory factors. It affects mostly women in the rural areas and not burghal centres.

“Some of the men do not animate their wives to go for ante-natal care. They will say, “When my mother had children, she did not go for ante-natal analysis and I am strong. Why allegation my wife appear ante-natal? Some appear and then, forth the line, they accord up.

“This is actual accepted in Gwer West and Goma Local Government Areas of Benue State. The bearings is abundant bigger in the burghal areas. We acquire been allurement abounding men to accompany their wives to ante-natal, but they don’t listen. It is alike a claiming absolution their wives for ante-natal care.”

Poor allotment and unfavourable govt policies

The bigger blackmail to the sustenance of chargeless HIV drugs, perhaps, is funding, which best states, as able-bodied as the Federal Government, acquire bootless to increase. According to statistics from NACA, the bulk of money approaching to accouterment HIV is beneath than a division of what is absolutely required.

For instance, Rivers State, which has the accomplished HIV prevalence bulk of 15.2 per cent, requires N839m to action the ache but alone N154m was approaching for HIV programmes in 2016, while alone N15m was released.

Similarly, in Nasarawa State, which has a prevalence bulk of 8.1 per cent, about N1bn was appropriate for HIV programmes, but alone N27m was appropriate it and N2.5m was eventually released. For Benue Accompaniment with a prevalence bulk of 5.6 per cent, N1.8bn was required, but alone N20m was accustomed in the 2016 Account and alone N5m was eventually released.

Cumulatively, in 2016, N19bn was bare for HIV programmes at the accompaniment level, but alone N5bn was approaching for while alone N865m was released.

According to the DG of NACA, alone nine out of the 36 states acquire surpassed the 50 per cent advantage for Anti-Retroviral Therapy, which has additionally led to the admission of mother-to-child manual of HIV.

He appropriate that states should set abreast one per cent of the account Federal Allocation for HIV programmes.

Aliyu added, “It costs about N50, 000 to accommodate ART to a actuality active with HIV for a year. With the admeasurement of our analysis programme (at over 1 actor PLHIV on ART), we will crave at atomic N50bn annually to accumulate them on treatment  while addition N100bn would be bare to ensure absolute advantage of the actual 2.2 actor not on treatment.”

President Muhammadu Buhari said aftermost year that he would advance admission to ART in Nigeria back he apparent the Fast Track Plan to abode an added 50,000 Nigerians active with HIV on ART every year.

He has additionally advised the advancing accouterment of ART to the 60,000 PLHIV in Abia and Taraba States beneath the Presidential Analysis Programme back the birth of this administration.

Similarly, the Federal Admiral of Health says it has adopted the 90-90-90 access in arrest the advance of HIV.

The Abbot of Health, Prof. Isaac Adewole, said it was attractive to analysis 90 per cent of Nigerians for HIV and additionally ensure that 90 per cent of those who are absolute get analysis and 90 per cent of those on analysis are virally suppressed.

Speaking afresh at the broadcasting affair of amethyst HIV 1 and 2 and self-test kit, saliva cassette and 10 antibody-based HIV accelerated analysis kits 2016 appraisal reports, Adewole said,  “What is additionally important is that this administering has adopted a 90-90-90 approach.We appetite to analysis 90 per cent of Nigerians. We appetite to ensure that 90 per cent of those who are absolute get analysis and so we articulation them up with analysis anon and we additionally appetite to ensure that 90 per cent of those on analysis are virally suppressed.”

Unfortunately, however, the Federal Government’s proposed 2018 Account appropriate the sum of N1.4bn for the analysis and administration of PLHIV. The armamentarium can alone baby for 28,000 people.

The abnegation or adjournment of the government to accord waivers for chargeless HIV drugs actuality alien is additionally a blackmail to the programme.

The Executive Secretary, Civil Association for HIV and AIDS in Nigeria, Walter Ugwuocha, said the government had been arresting the HIV programmes.

The CISHAN secretary said afar from the low account for HIV programmes, the government had been abnegation to admission waivers for alien HIV drugs donated to Nigerians by development ally and adopted countries.

Ugwuocha said such ‘irresponsible’ behaviour was what led to the accomplishment of HIV drugs account over $3.2m two years ago.

He explained that the United States Government, through its President’s Emergency Plan for AIDS Relief tagged ‘PEPFAR, provided drugs for over 700,000 Nigerians

Ugwuocha said the Nigeria government was allotment the analysis of beneath than 60,000 bodies active with HIV out of the one actor bodies on treatment, which is about bristles per cent, while the United States Government is allotment over 700,000 bodies and All-around Armamentarium and added donors baby for 150,000.

He said, “There are HIV, malaria and tuberculosis drugs account $20m donated by All-around Fund, accustomed advisedly to the Nigerian people, which acquire been ashore at the seaports for over four months. What the Abbot of Finance is accomplishing now is that she is abnegation to admission waivers and allurement that assignment be paid on the items.

“It’s not aloof drugs. We acquire two 40-ft containers abounding with mosquito nets aloof there and, afore you apperceive it, the shelf activity will expire. These drugs are not affordable ones. Some of them bulk as aerial as N100, 000.

“We cannot awning the actual 2.2 actor not on drugs, if we abide this way. It was article agnate that fabricated the N1bn account of HIV drugs expire not too continued ago. By the time the drugs access and are austere and get to the facilities, they are about expired.

“The aforementioned goes for analysis kits. Right now 168 actor Nigerians allegation testing, but out of that, we alone analysis 11 million. Why? Because we don’t acquire abundant analysis kits. Now, the All-around Armamentarium has donated over 30 actor analysis kits but we cannot acquire them because they are still at the ports.

“These are items that the Nigerian Government never acquired in the aboriginal abode yet, the ones donated by adopted governments and donor agencies are actuality blocked from advancing in. We acquire never heard of such a affair before.

“The abbot said the organisations allurement for waivers had not submitted their complete affidavit like affidavit of allotment and all of that, but that is a bruised excuse. NACA is a government agency. Is it allurement NACA to annals at the Corporate Affairs Commission?”

But the minister, Mrs. Kemi Adeosun, had on November 26 said that in acceding waivers, the  ministry  was afterward the procedures administering the acceding of acceptation assignment waivers to importers and NGOs.

She said this in a account active by the Director of Advice in the ministry, Mr. Salisu Dambatta.

This, she noted, was allotment of holistic measures put in abode to analysis abuses of the Federal Government’s budgetary incentives and to analysis base practices in the bread-and-butter sector.

She gave some of the procedures as the acquiescence of an appliance letter by the importer and NGO to the Federal Admiral of Finance through the Federal Admiral of Health; affirmation of allotment with the Corporate Affairs Commission; and acquiescence of an accustomed Memorandum of Understanding appropriately active by the Abbot of State, Account and National Planning amid the Donor Agencies, Federal Government of Nigeria and the Recipient-NGOs.

Others are the presentation of a affidavit of absolution from tax from the Federal Inland Revenue Service (only for those who appoint in non-profit authoritative activities in band with their objectives); acquiescence of a pro forma balance advertence the amount of the alien items, bill of burdened and if the alien items are donated, the NGOs are appropriate to accommodate the Federal Admiral of Finance with accurate letter from the donor agencies.

It reads in part, “The Federal Admiral of Finance has in contempo times empiric the arrant corruption of acceptation assignment waivers by some NGOs and importers, who banned added alien items into accustomed waivers issued for the access of medical accessories and biologic accompanying items.

“The admiral has additionally empiric that some importers and NGOs appoint in the auction of alien biologic items which are meant to be advertisement to the accessible chargeless afterwards actuality accepted acceptation assignment absolution by the government. This is in contravention of the accoutrement of Section 46 of the Customs and Excise Administration Act of 1958 (as amended).”

She said the admiral gave priorityto requests for acceptation assignment waivers for medical accessories and drugs-related items. She added that 318 acknowledgment applications had been accustomed and 175 were candy to cessation amid May 1 and November 24, 2017.

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