When a system fails, our children die…

A lot has been said and written about the HIV/AIDS epidemic since its emergence. No doubt, it is one of the most difficult infectious diseases to manage, and this is especially the case in our chameleon like hypocritical approach to issues relating to sexuality in Nigeria. Until we decide to take prevention seriously, which will mean actually speaking to our children about sex, then we will continue to be faced with the epidemic in our country, community and families. But lets leave aside sexual transmission of HIV for now, and deal with another mode of transmission that should be theoretically easier to deal with, and more within our control in the health sector to prevent – the mother to child transmission of HIV.

This happens when HIV, the virus that causes AIDS, is passed from a mother to her unborn baby during pregnancy, during birth or during breastfeeding. It can be relatively easily preventable by firstly establishing that the mother is HIV positive by offering all mothers attending antenatal services voluntary counseling and testing and if she turns out to be HIV positive, enabling access to antiretrovirals for the mother and child. This will protect the child from becoming HIV positive in most cases. As a country – we have failed to do this and now we suffer the consequences:

UN Report: Nigeria Has Highest Number of HIV Children Worldwide

An important report has just been published “2013 Progress Report on the Global Plan…towards the elimination of new HIV infections among children by 2015, and keeping their mothers alive”. It is a report that is well worth reading by every Nigerian. The first striking thing in the report is the categorisation of countries into 3; those showing a “rapid” decline (Botswana, South Africa, Ghana et al); moderate decline (Kenya, Cameroun, Zimbabwe et al) and slow decline; (Angola, Chad, DRC and our beloved country – Nigeria). At 76%, our neighbours, Ghana had the largest decline in the rate of children acquiring HIV infection! In South Africa, 24 000 fewer children acquired HIV in 2012 than in 2009, a decline of 63%. But, in regard to Nigeria, the report concluded …

Nigeria has the largest number of children acquiring HIV infection – nearly 60 000 in 2012, a number that has remained largely unchanged since 2009. 

So, is the problem a lack of funds? No! Despite its significant oil wealth and the well publicised 8% growth in GDP, Nigeria’s response to HIV/AIDS still relies heavily on donor funds. Through the US government’s PEPFAR programme, Nigeria received $488.6 million to support comprehensive HIV/AIDS prevention, treatment and care programs in 2011 alone, and this support has continued. Between 2003 and 2013, the Global Fund has disbursed about $1Billion in Nigeria. This is before you include funds from other donors and other budgetary allocations to respond to the epidemic, including through the National Agency for the Control of AIDS, which reports directly to the Presidency.

So ….why then are we failing our children so badly? This is not a question for government alone, but for all actors in the health space. This is a health system challenge; why can our health system not detect HIV in pregnant women that come to our health facilities, and why are we unable to provide the antiretrovirals to save our children’s lives? Why do we, together with these other four countries; Angola, Chad, DRC, Malawi provide Prevention of Mother to Child Transmission (PMTCT) services to less than 10% of our children.

Apart from our children, the situation with their mothers is even worse. Just 12% of mothers that are HIV positive and eligible for ARVs are getting these life-saving medicines. We are only better than one country on the continent – the DRC.

In addition to the questions we ask on the power sector, security, roads,…we have to include questions on our health sector. We must put these questions squarely on the national agenda. We have too much to lose if we don’t. Just too much….


Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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