Abarma, Nigeria—The radio announcer’s voice echoed in Mama Hamza’s head—Save the life of your unborn babies today by knowing your HIV status and doing what you have to do… Come out with your family and be counseled and tested. A group of health workers had arrived in her rural village in northern Nigeria, offering pregnant women what they were unable to get before—prenatal care along with HIV counseling and testing. Throughout her pregnancy, Mama Hamza had been sick and she worried about the health of her unborn child. Now was her opportunity to find out if she was carrying the virus that causes AIDS.
The radio ad was part of a Jhpiego effort to support the government of Nigeria’s goals to bring essential health care to women where they live and increase access to HIV prevention, care and treatment services.
In remote Abarma, women had been unable to travel to the Dr. Karima Women and Children Clinic in Gusau for prenatal care and other reproductive health services. When a group of Karima health care workers learned about the need in Abarma, they decided to travel there and offer prenatal services, including HIV prevention and screening, in the village. Integrating HIV services with maternal and child health care and family planning ensures that women get the services they need in one location.
“After I was told that the women at Abarma were not getting ANC (antenatal care) services, I felt it will be a good opportunity to provide HIV counseling and testing outreach services as part of an antenatal care package, and we went ahead to schedule a date to visit the community and provide the service,” said Hajiya Fatima Abubakar, a community health extension worker at the Dr. Karima Clinic who led the outreach to the women of Abarma.
Providing HIV counseling and testing services through outreach to communities is one of the strategies used by the Zamfara Akwa Ibom HIV/AIDS Project (ZAIHAP), an initiative funded by the President’s Emergency Plan for AIDS Relief/U.S. Centers for Disease Control and Prevention that has served more than 60,000 women, men and children in Zamfara and Kano states. The project targets vulnerable populations in remote areas and makes HIV prevention services a priority for women and families who wouldn’t receive them otherwise. AIDS remains the leading cause of death among Nigerian men and women of reproductive age in a country with an estimated population of more than 150 million people.
Abubakar and her colleagues held group health education sessions in Abarma, offering information about HIV/AIDS and the “opt-out” approach to HIV testing, which tests unless a client declines it. They explained the steps an HIV-positive woman would take to avoid transmitting the virus to her unborn child and how to care for herself to remain healthy. They also outlined the extent of care, treatment and support available to HIV-positive clients and their families. Linking HIV-positive mothers to care and treatment helps keep such mothers alive and healthy. Forty-one pregnant women showed up for the clinic that day and all were tested for HIV. Four clients with positive results were referred to the Dr. Karima Clinic for further care and treatment and were provided transportation to reach the clinic six miles away.
For Mama Hamza, her visit to the prenatal care clinic ended happily. “I was relieved to know I was HIV-negative,” said the young woman, who gave birth to a baby boy she named Hamza. “I had heard many things about HIV on the radio and I was afraid. After Hamza was born, he developed a high fever but I was not afraid since I knew from the health education that we got during the Hajiya Fatima’s visit that it could not be HIV.
“I took him to the hospital and he was treated on admission for some days, then discharged,” said the proud mother. “He is three months old now and doing okay.”
Mama Hamza and other women of her age had reason to be fearful. In 2008, 2.95 million Nigerians were estimated to be living with HIV. On average, 294,000 Nigerian infants are exposed to the virus annually. With mother-to-child transmission rates between 25 and 45 percent, a devastating 73,500 to 132,300 infants will acquire HIV infection during pregnancy or delivery or through breastfeeding each year unless services for prevention of mother-to-child transmission (PMTCT) are greatly expanded. PMTCT services are currently being offered in just 8 percent of the primary, secondary and tertiary health care facilities in the country.
The ZAIHAP Project is a successful collaboration between the Nigerian government, Centersfor Disease Control and Prevention and partners involved in the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program (MCHIP). The goal of this collaboration is to build the capacity of health care workers to deliver HIV prevention and treatment services in Zamfara and Kano states and strengthen health facilities there.
In Zamfara state, the partnership of Jhpiego, Save the Children (US) and two local nongovernmental organizations, the Community Health Development Project and Federation of Muslim Women Associations in Nigeria, produced the radio ads and community awareness campaign.
Since the ZAIHAP Project began in 2008, Jhpiego and other partners have helped organize twice monthly visits by community health workers to provide services to the pregnant women of Abarma and their families. Health workers have reported an increase in pregnant women attending the monthly educational sessions in Abarma.
“The women who tested positive were surprised at their results. But they all unanimously agreed that it is better now that they know their HIV status and can take steps to prevent transmission of the virus to their babies,” said Abubakar, the community health extension worker. “I’m so happy because I will say that the training I have received from Jhpiego since this project started in my facility is far more than what I received when I was being trained in school.”
Jhpiego and other partners have offered to create maps of other villages in the Gusau area for identifying women at risk and to find creative ways to provide PMTCT services to those in need.
Since 2008, the ZAIHAP Project has provided PMTCT services to more than 60,000 pregnant women and also provided support for many of the women’s children and partners. Other accomplishments to date:
- Provided HIV counseling and testing services to more than 40,000 clients, with emphasis on the most-at-risk;
- Educated and trained more than 150 health care providers and community volunteers on various aspects of PMTCT/HIV counseling and testing services, community mobilization, monitoring and evaluation, and quality assurance controls; and
- Provided more than 170 HIV-positive pregnant women with antiretroviral prophylaxis and referred over 350 men and non-pregnant, HIV-positive women to comprehensive sites that provide antiretroviral therapy.
HIV counseling and testing remains a critical tool in prevention efforts and a gateway to care and treatment. But universal testing is not available in most communities. HIV counseling and testing outreach services help to bridge the access gap, and ZAIHAP continues to support outreach services to vulnerable populations in hard-to-reach communities.
“Our women and children are suffering a lot of health problems here . . . ,” said Mama Hamza. “Thank God that Jhpiego is supporting facilities to provide these free services. I wish they can come and stay permanently in our hospital and community.”