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Why Nigeria has more HIV-positive infants than anywhere else

Preventing mother-to-child HIV transmission is considered one of the most basic goals for curtailing the AIDS epidemic, and Nigeria is struggling mightily. In our series The End of AIDS, William Brangham and Jason Kane examine why this oil-rich nation is falling so badly behind, and profiles a unique, church-based program that’s showing real promise.

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  • Judy Woodruff:

    Now the next in our series on the challenge of ending the AIDS epidemic.

    Earlier, we visited Russia and looked at the difficulties that nation is having with its epidemic.

    Tonight, with support again from the Pulitzer Center, we travel to Nigeria, a nation that's just 2 percent of the world's population, but accounts for almost a quarter of all HIV-positive babies.

    William Brangham and producer Jason Kane report how one innovative program is showing some remarkable promise.

  • William Brangham:

    The rhythm of Sunday morning in Central Nigeria is slow and steady. Close to 1,000 people pack St. Vincent de Paul Church in Benue State, outside the town of Aliade. Singing. Praying. Offering thanks.

    This may seem like just a traditional Sunday Mass, but what's going on in here is one of the most effective ways of stopping the spread of HIV.

    At the end of Mass, the priest asks any pregnant women and their partners and children to come forward. About 50 people gather near the altar.

  • The Rev. Emmanuel Dagi:

    Defend these mothers and these fathers and their children from every evil. Be their companion along their pathway through life.

  • William Brangham:

    They're given a blessing and invited to a special celebration later that's just for them. They're told there will be gifts and dancing. And some medical care — malaria tests, high blood pressure…

    But the one thing that's not mentioned, the one that's the main point of this program is HIV.

    Amaka Ogidi helped develop this program, which is called Baby Shower.

    She says that because of the stigma around HIV, they just can't say it at the beginning.

    Do you think if the priest got up there and said, 'We will give you HIV testing,' do you think anyone would stand up?

  • Amaka Ogidi:

    Maybe. Maybe one or two. But, of course, if they stand up and they're coming, others would, 'Shhh, why is he going for Baby Shower? Why is he going for the test? That means he must have been living a very devious life.'

    But when you come to the main shower now, you will get the full detail.

  • William Brangham:

    And that's by design?

  • Amaka Ogidi:

    That's by design. It's no mistake. It's purposely planned.

  • William Brangham:

    After Mass, the pregnant women and their partners are weighed and measured and screened for various conditions, things like hypertension and hepatitis B, which are also real problems in Nigeria. But the key test is HIV.

  • Amaka Ogidi:

    We need the first 20 completed, so that they can have their shower.

  • William Brangham:

    The goal is to find pregnant women who are infected and get them on antiretrovirals. It will protect them from developing AIDS, but it will also greatly lower the risk that they will transmit HIV to their babies.

    Left untreated, that transmission happens roughly 30 percent of the time. This kind of effort in Nigeria is long overdue. Two hundred miles away, in the capital, Abuja, 3-year-old Mubarak Isah is dying of AIDS. His mother already died.

    In 2016, roughly 24,000 children died of AIDS-related causes in Nigeria; 12-year-old Yusuf Adamu is also very sick. He, too, lost his mother to AIDS.

    In Nigeria, roughly 37,000 children were newly infected in 2016. Over a quarter of a million are living with the virus.

  • Jon Cohen:

    The sorest thumb here, the biggest problem is mother-to-child transmission, because it's so easy to stop, relatively speaking.

  • William Brangham:

    We traveled to Nigeria with Jon Cohen. He's a reporter for "Science" magazine who's covered HIV/AIDS around the world, and he was our partner on this series.

    Cohen says that after antiretroviral drugs proved their worth in the mid- to late-90s, the world's wealthiest countries pooled their money to help beat back the epidemic.

  • Jon Cohen:

    The first thing they targeted was pregnant women who were infected, because if you got drugs to the women, it cut the rate of transmission dramatically. And as the drugs got better and better, it basically took the rate of transmission down to almost zero, under 1 percent.

  • William Brangham:

    But those efforts have fallen short in Nigeria. One out of every four babies born worldwide with HIV is born in Nigeria.

  • Dr. Sani Aliyu:

    That's really not acceptable, considering that it's a condition that you can actually abolish.

  • William Brangham:

    Dr. Sani Aliyu leads Nigeria's National Agency for the Control of AIDS.

  • Dr. Sani Aliyu:

    My argument has always been, within the general population level, it's going to be a lot of work to put everybody with HIV on treatment.

    For pregnant women, it's not the case. Their numbers are small compared to people living with HIV within the general population. So it should be achievable, really. It should be low-hanging fruit.

  • William Brangham:

    Cue the Baby Shower program. Between the testing and waiting for the results, there's a lot of this: singing, dancing and gift-giving.

  • Amaka Ogidi:

    After singing and dancing, we use this to support them.

  • William Brangham:

    So this is a gift for them?

  • Amaka Ogidi:

    That's the Baby Shower gift. We call it, 'Mama Pack.'

  • William Brangham:

    Mama Pack?

  • Amaka Ogidi:

    Yes.

  • William Brangham:

    And what is in there?

  • Amaka Ogidi:

    OK. What we have here, actually, are the things that will aid them in delivery.

  • William Brangham:

    The Mama Pack contains basics like diapers and sanitary pads. But there's also medical supplies — rubbing alcohol and clamps for the umbilical cord. These are necessities the hospital would charge for.

    About 40 percent of women here don't give birth in hospitals. They will stay at home or visit local birthing attendants. Part of this is just tradition, but part is also the cost.

    The hope is that the Mama Pack will steer moms to hospitals, where they will get better care, especially if they're HIV-positive.

    So if they come in with this bag, they save money.

  • Amaka Ogidi:

    They save not just money, but we are sure of the quality they are going to use.

  • William Brangham:

    Within a few days of the church service, the Baby Shower team sets out to track down the women who tested positive, and begin their mission of gentle nagging.

  • Amaka Ogidi:

    Hello.

  • William Brangham:

    They want to make sure moms visit the clinic and start their medications.

  • Amaka Ogidi:

    [We say,] "Why have you not gone to the facility? You want to carry a baby infected? Oh, make sure you go. How soon are you going?"

  • William Brangham:

    So you don't let them fall out of care.

  • Amaka Ogidi:

    That's the issue.

  • William Brangham:

    Several months ago, new mother Felicia Adah got the full Baby Shower treatment.

    Did you have any reason to believe that you would be HIV-positive?

  • Felicia Adah:

    No. I no believe like that. But when the test come, I was crying. Two weeks, I did crying.

  • William Brangham:

    But she started on treatment, stuck with it, and her baby was born virus-free. She says she wouldn't have gone for care on her own.

    And no matter how far away expectant mothers live, Baby Shower staff are relentless in finding them and keeping a close watch.

  • Amaka Ogidi:

    You want to prevent. If she misses her dosage and misses, those viruses comes out again with more aggression, and start multiplying and looking for the cells to destroy. They could destroy your baby, you know.

  • William Brangham:

    Mbachie Kough and his wife, Rose, are both HIV- positive. And they're both in the Baby Shower program. And their new baby girl was born healthy and virus-free. The program teaches parents how important it is to stay on medication, so the babies don't get the virus through breast-feeding.

  • Mbachie Kough:

    The counselor told us what to do. If we didn't follow the instruction, the baby might be likely to get the virus.

  • William Brangham:

    The Baby Shower program is now in 115 churches in Nigeria. Ninety percent of Nigerians attend a place of worship at least once a week. Nigeria is also half-Muslim, and they hope to include mosques in the program soon.

    Father Emmanuel Dagi is the priest here.

  • The Rev. Emmanuel Dagi:

    Our people are so very religious. And, because of that, they attach much importance to the priest, also. And if something comes through the priest, they accept it wholeheartedly.

  • William Brangham:

    Initial results show that Baby Shower is working. A recent study funded by the U.S. National Institutes of Health found that 92 percent of pregnant women in Baby Shower got an HIV test, while only 55 percent of women outside the program did.

  • Jon Cohen:

    That's a remarkable achievement. That's a great step forward. The single biggest problem is: people don't know their status. They don't know whether they're infected. If you don't know you're infected, you're not going to get treatment.

    And if they can capture 92 percent of the women to learn their status, that gets into the zone of really driving transmission toward elimination.

  • William Brangham:

    They're now looking at whether the program dramatically cuts mother-to-child transmission.

  • Amaka Ogidi:

    Baby Shower, I just love it. I told somebody that it spreads like perfume. You can spray it here. Somebody else, somewhere, 'Mmm, mmm! What is that?!' And comes looking for what it is. The perfume is spreading. Baby Shower is producing some amazing results.

  • William Brangham:

    Six weeks after the babies are born, families are called back to church for what's known as baby reception. There are follow-up tests and some lessons reinforced.

    But, above all, they celebrate a healthy birth and what they hope will be a turning point for their country, a generation born free of HIV.

    For the "PBS NewsHour," I'm William Brangham in Benue State, Nigeria.

  • Judy Woodruff:

    Tomorrow night, we turn to the fight against HIV here in America, and go to Florida, home to four of the top 10 cities in the U.S. for new HIV diagnoses.

    Our partners at "Science" have all of Jon Cohen's reporting from this series in their current issue and online.

    You can find a link to that and all our broadcast pieces on our website. That's PBS.org/NewsHour.

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