About two years ago, Rosemary, 30, went to the clinic for antenatal check-up. After series of test, she was told that she was HIV positive. The nurses counselled her. She says the counselling provided at the clinic boosted her morale. She said to herself then that God knows everything that happen to mankind and knows how to give her help.
Rosemary is the 3rd wife of her husband. In her culture, men are permitted to marry more than one wife. Before she got pregnant, Rosemary says she heard rumors that the other women (wives of her husband) were HIV positive. She confronted her husband about it but he dismissed the news and told her he didn’t know anything about their status.
When she got the news of her HIV status, she went back home to tell her husband, but he dismissed her report, nonchalantly.
“I had to encourage her that being positive is not the end of life,” says the Nurse at the Antiretroviral Treatment (ART) centre at the clinic where Rosemary access treatment. “I also encouraged her that if she takes care of herself and her pregnancy, the child will be free from the disease.” The nurse shared different stories of positive women who successfully gave birth to HIV negative babies as well as those who failed to adhere to treatment and thus delivered HIV positive babies. The stories encouraged Rosemary.
Women, especially pregnant women and nursing mothers, who have tested HIV positive in Nasarawa state are encouraged to access free medical treatment and drugs. The test and antiretroviral drugs are free, says the head nurse, Prevention of Mother To Child Transmission (PMTCT) treatment centre, in one of the secondary health clinics in the state.
Although new HIV infection is said to be on the decline globally, Nigeria still ranks high with a population of over 3million people living with HIV in the country. There is still work to be done. One of which is mobilizing pregnant women and their spouses at the rural areas to adhere to their treatment, to ensure their well-being and that of their children.
“Rosemary comes for her drugs regularly,” says the ART Nurse. “Even today she came for her treatment thinking it was her appointment,” she said. But all efforts to get her husband to come for HIV test have not been successful.
Rosemary’s child is one year and five months and is still HIV negative.
“After one year and six months we do the last test,” says the ART nurse. At that point, if the baby remains negative, the PMTCT service is regarded as successful.
With the current PMTCT guideline of “test and treat” women whose test result reveals HIV positive are placed on ARVs treatment immediately.
“It is because the viral load may be high at that time. The higher the viral load, the higher the chances of the virus infecting the child,” says the nurse.
To prevent mother to child transmission of HIV, treatment intervention is provided during pregnancy, at labour and delivery and during breastfeeding.
HIV status of partner unknown
Although Rosemary considers herself fortunate to have successfully adhered to the process of PMTCT treatment, she is still perturbed by her husband’s refusal to go for HIV test. She classifies this as a challenge.
She says they are told at the clinic that if a woman is HIV positive and the man’s status is not known and they are both sexually active, then the man is likely to be infected. And if he is already infected, he has the chances of increasing her viral load even though she is already accessing her ARVs.
To prevent herself from being at risk of increased viral load, Rosemary says she sometimes refuse him sex but she is forced to succumb to him, as part of her duty as a wife. She says she has no option than to keep living with it.
The health clinic is careful not to interfere with family issues.
“We have invited him severally to come for test but he refused,” says the nurse. They have continued to encourage Rosemary to access her treatment. “But if he refused to allow [her] access, we will take legal backing. Everyone has a right to treatment as well as right to life,” she says.
HIV awareness is increasing in Nasarawa state, even though the state still account for one of the highest prevalence rate of 7.5% in the country. People access treatment irrespective of their religious background, says the nurse.
“What we normally tell them is that when you are HIV positive, you know your status, live positively and take care of your life. If you are HIV negative, it does not mean you cannot be positive tomorrow. Try to avoid those things that can make you infected.”
No stigma and shame
Rosemary says she does not pay attention to any form of stigma. When she comes for her ARVs at the clinic, she does not mind the stares she gets from those around. She says all she knows is that she is there to take care of herself and her family. Accessing treatment is doing something that will make her life better.
Some people who are HIV positive do not adhere to treatment because of shame and stigma. Rosemary says there is need for everyone who is HIV positive to take care of themselves. She has taken care of herself and her baby is HIV negative, she says.
She looks forward to having more children. But not immediately, she adds, smiling.