By CHIOMA UMEHA
Experts have continued to advocate for the integration of HIV and family planning services as part of a comprehensive strategy to prevent unplanned pregnancies and HIV transmission from mother to child.
According to studies, the comprehensive strategy is the most effective way to increase contraceptive use among women who want to avoid or delay pregnancy in order to prevent HIV transmission to their children.
Unfortunately, Nigeria is one of the countries where a number of health-care system barriers are preventing the effective and long-term delivery of family planning and HIV services under one roof. Despite the fact that Nigeria has signed global agreements, there are significant gaps in translating policy support into widespread practice. This is just as research has proven PMTCT as a better strategy for HIV management in children as the new antiretroviral treatment (ART) is still at the pilot stage in the country.
Regrettably, programmes to prevent mother-to-child transmission of HIV continue to be implemented and evaluated as a narrow set of interventions that typically begin in antenatal care, after a woman is already pregnant. This is one of the reasons for the growing number of HIV infections and deaths among Nigerian newborns and children. The National AIDS and STIs Control Programme (NASCP) reports that 409 and 833 Nigerian babies were HIV positive in 2020 and 2019 respectively. Regrettably, the country also recorded 808 HIV positive babies in 2018, while the figure was1,359 in 2017.
The United Nations Children Fund (UNICEF) reports that more than 47 children and adolescents died every day from AIDS-related causes across the country in 2018, according to a global snapshot on children and HIV/AIDS. The reasons are not far-fetched. Low access to antiretroviral treatment and limited prevention efforts are the leading causes for these deaths, with only 54 percent of children aged 0-14 living with HIV globally in 2018 -or 790,000 children - receiving lifesaving antiretroviral therapy.
Voluntary family planning to enable women and couples to determine the timing and spacing of their pregnancies have long been recognised as a basic human right. Sadly too, data indicates that women living with HIV experience high rates of unmet need for family planning and unintended pregnancies. Experts confirm the contributions of family planning to global health and development, including the achievement of the Sustainable Development Goals (SDGs).
The 2012 epoch-making London Summit on family planning canvassed support for the far-reaching benefits of family planning, leading funders, government leaders and other partners to commit to expanding access to contraception and rights-based family planning services to an additional 120 million women and girls. For women and couples living with HIV who do not wish to become pregnant, family planning offers the added benefit of helping prevent mother-to-child transmission of HIV (PMTCT).
Also, in 2003, the World Health Organisation (WHO) and its partners conceptualised a comprehensive framework for PMTCT consisting of certain core elements. These include, primary prevention of HIV among women of childbearing age; prevention of unintended pregnancies among women living with HIV and prevention of transmission from HIV-infected women to their infants. The fourth element is the provision of treatment, care and support to HIV-infected women and their children and families
Ten years later, this four-element strategy continues to provide the foundation for current global commitments to eliminate new pediatric HIV infection. These include the Global Plan Towards the Elimination of New HIV Infections Among Children By 2030 and Keeping Their Mothers Alive. The centrality of family planning to MTCT elimination is clearly articulated in both of these commitments.
To achieve this goal, prevention of unintended pregnancies among women with HIV must be elevated as a programmatic priority in Nigeria. While the importance of family planning to achieving the end of new pediatric HIV infection is recognised in relevant policy statements, few PMTCT programs have increased access to contraception for HIV-infected women and couples who do not wish to become pregnant.
A change in how PMTCT HIV programmes are conceptualised, implemented, and evaluated is needed to better address the contraceptive needs of HIV-infected women and accelerate progress toward ending HIV infections among Nigerian children. Increased implementation of evidence-based comprehensive family planning and HIV services would boost the use of family planning in eliminating mother-to-child transmission of infection in Nigeria.
To this effect, PMTCT and other HIV service delivery implementers, policymakers, and funders should also adopt family planning interventions as a routine component of their programmes. Transforming services in this way will help HIV-infected women and couples achieve their desired timing and number of children and, in turn, lead to gains on both reproductive health outcomes and elimination of mother-to-child transmission of HIV.
Consequently, women who want to become pregnant could be supported to plan for safer conception and access ART services to reduce the risk of HIV transmission from mother to child. Those that do not want to become pregnant could be supported to access and use family planning. Indeed, combining family planning and HIV programs for women as a holistic service will speed up progress toward eradicating new HIV infections among children.