In commemoration of the 2024 World AIDS Day, the Director General of the National Agency for the Control of AIDS (NACA), Temitope Ilori, shared insights into Nigeria’s ongoing battle against HIV/AIDS, particularly the challenge of mother-to-child transmission (MTCT).
With Nigeria being one of the countries with the highest burden of MTCT, Ms Ilori, a doctor, discussed the progress made, the challenges faced, and the strategies in place to ensure no child is born with HIV.
PT: What progress has Nigeria made in reducing mother-to-child transmission of HIV and what are the latest statistics on the impact of PMTCT programmes?
NACA DG: Nigeria as a country has made significant progress in the Prevention of Mother-to-Child Transmission of HIV (PMTCT). However, we still have a long way to go. We still have a challenge putting a stop to Mother-to-Child Transmission of HIV (MTCT) and I think the challenge is multifaceted. While HIV drugs are available at health facilities, only about 66 per cent of mothers receive antenatal care in these facilities. Even among those who do, only about 23 per cent deliver in health facilities. Many women receive antenatal care but give birth at home, with Traditional Birth Attendants (TBAs), or in mission houses. For those who test positive for HIV, stigma and fear of discrimination often prevent them from accessing treatment. As a result, only about 33 per cent of pregnant women are on antiretroviral therapy (ART), far from the 95 per cent global target. This places Nigeria as the country with the highest burden of MTCT and the highest number of children born with HIV. We are working hard to reduce this burden by encouraging pregnant women to seek antenatal care, get tested for HIV, start treatment, and deliver in health facilities with skilled birth attendants. The availability of HIV drugs is not the issue—what we need is for women to access care without fear of stigma. We all as Nigerians should ensure that we stop stigma and discrimination, we should embrace those living with HIV, support and encourage them to stay on treatment. When mothers are on treatment and their viral load is suppressed, the virus becomes undetectable, which means it becomes untransmittable to their unborn children.
PT: What are the key challenges hindering effective PMTCT implementation in Nigeria, especially regarding access to services?
NACA DG: One of the main challenges is cultural beliefs. Many women prefer to give birth at home or with TBAs rather than in health facilities. We are working closely with traditional and community leaders, networks of people living with HIV (PLHIV), and mentor mothers – those living with HIV and already on treatment – to support and encourage pregnant women to access health services. Religion also plays a role, which is why we partner with faith-based organisations to share these messages in places of worship. Stigma and discrimination remain the most significant barriers preventing women from seeking HIV testing and treatment. Overcoming these challenges is critical to improving access to PMTCT services.
PT: Stigma and discrimination often deter women from accessing PMTCT services. How’s NACA addressing these barriers?
NACA DG: We have anti-discriminatory laws that are now domesticated in several states across Nigeria. These laws penalise individuals found guilty of discrimination. Additionally, NACA has established a workplace policy that allows individuals who face discrimination to report it and have the issue addressed. We also conduct the stigma index survey, in collaboration with networks of PLHIV, to measure the prevalence of stigma and track our progress. This helps us identify hotspots and inform our policy decisions. By continuously monitoring stigma levels, we can implement targeted interventions to reduce its impact on healthcare access.
PT: How is NACA working to ensure that PMTCT services reach more pregnant women, particularly those in rural and underserved areas?
NACA DG: We’re not just waiting for women to come to health facilities; we’re going out to find them. We partner with Civil Society Organisations (CSOs) and NGOs to conduct community outreach, offering HIV testing and treatment where necessary. Health workers and volunteers play a vital role in this mission. We also ensure that pregnant women, especially in underserved areas, are included in the National Health Insurance Authority (NHIA) under vulnerable groups, which is funded through the Basic Health Care Provision Fund (BHCPF), which is one per cent of the consolidated revenue. Over the past year, more than two million vulnerable Nigerians, including pregnant women and PLHIV, have been enrolled in the scheme, ensuring they have access to the healthcare they need.
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PT: With declining global funding for HIV/AIDS, how is NACA ensuring the sustainability of PMTCT services in Nigeria?
NACA DG: We are engaging with state agencies and local government authorities to ensure that PMTCT services are sustained at the grassroots level. NACA collaborates with state agencies and local governments to oversee and implement HIV/AIDS programmes, including PMTCT. We are also advocating for increased budgetary allocations for HIV response at both national and sub-national levels. Through the Global Fund grant, resources are mobilised to support these activities across all states. Additionally, we are integrating HIV services into Primary Healthcare services and training healthcare workers at the local government level. To date, we have trained over 20,000 healthcare workers, with plans to train 120,000 by the end of the programme.
PT: What are NACA’s key plans to meet the UNAIDS 2030 goal of eliminating mother-to-child transmission of HIV in Nigeria?
NACA DG: One of our key plans is the acceleration committee, inaugurated by the Minister of State for Health and Social Welfare, which we aim to replicate in all states. It has already been domesticated in three states – Ekiti, Ogun, and Borno -where local governments have committed to allocating resources and providing the necessary political will to eliminate MTCT. We are also intensifying awareness campaigns, using media, town criers, and market outreach to reach more people. We are working closely with TBAs and other non-conventional health facilities, providing them with HIV test kits and training them to refer pregnant women who test positive to skilled healthcare facilities for treatment. Our focus is on preventing new infections and ensuring that over 98 per cent of Nigerians who are currently HIV-negative remain that way.
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