Mixed Blessings: Women Contacts HIV While Seeking For Babies

Punch is reporting the sad stories of women who contracted HIV while desperately seeking to have children and the societal pressure that pushes them into the hands of quacks and pseudo-medical centres

 I got HIV in the process of looking for a child,” says Mrs. Titi Okunowo with a sad smile. “I got the child but it came with what I didn’t bargain for — a virus I may live with for the rest of my life.”

Globally, sexual transmission is responsible for 75 per cent of HIV infections. But Okunowo did not contract HIV through sex. It all started with a love story.

When Okunowo met with the man that would become her husband, it was almost love at first sight. But her husband’s family opposed their union. So, when they tried for a baby and there was none coming, Okunowo began to fear for the future of her marriage.

“I didn’t want to lose my husband. I didn’t want him to look outside for another woman who could bear him a child. I wanted to protect my marriage and I also feared my in-laws’ wrath,” she says.

Okunowo is one of the 3.1 million Nigerians who have the Human Immunodeficiency Virus in their bloodstreams. According to the National Agency for the Control of AIDS, 58  per cent of the members of this group are women but only 23 per cent of women in Nigeria have comprehensive knowledge of HIV transmission and prevention issues.

Driven by the desperation to have a child and save her home, Okunowo went looking for help at hospitals and trado-medical centres. She moved from doctors to herbalists, submitting her body to injections, incisions, transfusions and all manner of invasive procedures. In her desperation, she did not request any of the doctors or herbalists to sterilise the tools or use new ones.

She says, “I won’t lie to you. I visited everyone and everywhere I could to get a child. Once I hear that someone somewhere can help me get pregnant, I would run there as far as my legs could carry me. Name the state, I have been there. And I am not talking about hospitals alone; I also visited herbalists in three different states.

“I went through all sorts of procedures, both medical and ‘native’ in my desperation. Some of the places where these procedures took place were not neat but I didn’t care. Neatness and safety was the last thing on my mind. I did not ask if they sterilised their blades or not.  I just needed a child. I needed to keep my home.”

With her eyes misty and dark, she recalls one of the places where she once sought help: “It was such a filthy place. Sharp metals that had been used for some incisions lay on the floor; some were covered with little blood. At a corner, some animals lay, to be used for sacrifice. The herbalist that gave me the incisions did not wear a glove or anything. He did not sterilise the blade he used. But all these did not matter to me then.”

Her indifference would later haunt her. But first, Okunowo got pregnant in 2003. She gave her husband the good news and returned to school to sit her final exams. When the pregnancy was two months old, she started bleeding.  She went to a dispensary to get some drugs to stop the bleeding.

“Even the chemist (dispenser) was a quack. I have to tell you the truth so that others can learn from my story. He gave me all sorts of drugs and assured me that the drugs would stop the bleeding,” she says.

The bleeding stopped but Okunowo’s problems had just started.

When she was six months gone, she started bleeding again and went for a laboratory scan. She was told that her baby was deformed due to the drugs she had been taking and that the child had little chances of survival.

Advised to abort the baby, Okunowo then went to another hospital in the Alakuko area of Lagos State and requested for the foetus to be evacuated.

With the loss of the pregnancy, Okunowo hit the road again to search for a new baby.

She started making the rounds of hospitals and herbal centres. “Some would say I needed to flush my tubes, others would give me all sorts of injections. I did them all,” she adds.

Shortly after she got pregnant again in 2005, she fell ill and was advised by her doctor to undergo some tests to ensure that her baby was in good form. When she went to collect the result, she noticed hers was in a brown envelope. Others collected theirs in white envelopes.

“I knew something was wrong. I asked the receptionist why my result was in a brown envelope. She just stared at me. So, I walked to the corridor and opened the envelope. The result said I was HIV positive.

“I wanted to die. I thought my world had come to an end. The pregnancy did not matter anymore,” Okunowo says.

She fled to her elder sister’s house, crying with the fear that her life was over. While there is growing awareness about HIV/AIDS issues in Nigeria, many Nigerians still see an infection as a death sentence.

AIDS is the leading cause of death among women of reproductive age (15- 49 years) and the prevalence rate among young women aged 15- 24 years is  three times higher than among men of the same age. Stigmatisation, though dying out, is very common.

But where Okunowo expected condemnation, she found support.

She says, “My sister and mother are my confidants. I can tell them anything.  When I got to my sister’s house, I was sobbing. But I was shocked by her courage. She called my mother and both of them told me that it was not the end of the world.”

Then, her mind moved to her husband: Was he infected? Did he give her the virus? What would happen to their union?

She says, “I first thought that he might have infected me, even though we were both HIV negative when we got married. When I summoned the courage to tell him that night, he said he would test himself too. He did and he was negative.”

Okunowo then began a quest to know how she got infected with the virus. She found the answer through counselling.

She says, “In my first counselling class, I was asked about my sexual life and health practices.

“I was told that in the process of visiting quacks, herbalists and unlicensed health professionals, I must have contracted the virus because of the unhygienic conditions of the places I visited.”

While Okunowo could count on the support of family when she learnt about her status, there was no one to offer Mrs. Fola Jegede a shoulder to lean on. When she and her husband tried and they could not have a baby, she began to seek doctors and herbalists out for help.

“Once I hear that one doctor knows how to help a woman get pregnant, I will go there. The state of the hospital or herbal centre was the least important thing on my mind. I didn’t think about professionalism. I went everywhere. The condition of some of the places I visited was horrible but having a child was what was on my mind.

“I opened my legs for all sorts of medical treatment and took various injections without asking for once if the person was competent or if the procedure was hygienic.”

Then she got pregnant and gave birth to a girl in 2006.

After one year and six months, she began to fret again. Her daughter was not walking. So, she took her to the hospital.

“The doctor asked that some random tests be done and it was discovered that she was HIV positive. I was dazed. Immediately, the doctor asked that I check my status and it was positive too. I went blank.  My legs were heavy; I didn’t know my way home again. Different thoughts raced through my mind. When we first got married, my husband and I were HIV negative and I was a virgin.

“So, I sent my husband a text message that the tests showed that our daughter and I were HIV positive. My heart was beating very fast. I didn’t know what his response would be.”

A few minutes after, she received his response. He asked her to come home.

On getting home, she says she could not look into her husband’s eyes.

“I pray no woman goes through such. I felt condemned. I was looking at my feet. Then he said he was going to do the test. All through the night, I could not sleep. I cried as if my life was over. I kept telling myself that since I married my husband a virgin, he had no reason to doubt me. I was faithful to him.”

When the results came out, her husband was HIV negative.

“It’s not that I wanted him to test positive, but you know, misery likes company.  That he was negative made me feel guilty, even though I didn’t know the reason why. I told my mother and she said it must remain a secret between my husband, herself and I,” she states.

One morning, her husband left the house and didn’t return.

She says, “Testing positive strained our marriage but I didn’t know he could leave me. He went away for six months. I wanted to die. I knew he left because he was shocked, scared and disappointed. All entreaties failed and I thought I would be a single mother for the rest of my life.”

But her husband returned home one morning and said he could not do without her.

She says, “He told me that I was his best friend in the world and the only person that he trusts. He said he had thought about it and felt the virus should not separate us. I cried again because I didn’t know he would come back. Now, he is my biggest cheerleader. He reminds me to take my drugs and we have another child that is HIV negative.”

Through counselling, Jegede also established that she got infected with HIV during her search for a baby.

Nigeria has over 1,000 federal and state health care institutions and countless number of private health care facilities.

But experts have said medical facilities are inadequate, poorly staffed and funded, and millions of Nigerians prefer to patronise cheap quack doctors or trado-medical centres.

“The ratio of patients to doctors in Nigeria is appalling. It is one doctor to 8,000 people. In the USA and UK, it is one doctor to 100 people,” Dr. Osahon Enabulele, the National President, Nigerian Medical Association, said recently.  “The total number of doctors in Nigeria is not more than 20,000. And how many of them are still actively practising? In Lagos State, there are less than 2,000 who are actively practising. When it is only one or two doctors that attend to hundreds of people in a day, there will be problems.”

According to UNICEF, about 60 per cent of Nigerian women give birth at centres run by unskilled birth attendants. These unskilled attendants include poorly trained health workers, traditional healers and herbalists, and unskilled midwives who run some of the hospitals owned by churches.

UNICEF says, “In addition, only slightly more than one-third of births are attended by doctors, nurses or midwives. The consequences of the poor state of pregnant women in Nigeria are numerous and affect maternal as well as child mortality.”

Studies have shown that an average of one Nigerian woman dies every 10 minutes from complications related to pregnancy and childbirth. 500 newborns die daily from the same causes.

In Nigeria and most African societies, the pressure for couples to have children after a wedding is huge. Health and social workers say the number of women who contract HIV while seeking pseudo-medical help for conception are not known and the phenomenom has not been studied. But they aver that societal pressure on childless women may be pushing many in the direction of quacks in a country where healthcare services are poor.

A child rights advocate, Betty Abah, who deals with women and child rights, says the Nigerian society is unkind to childless marriages.

“It boils down to the culture that a married couple is not seen as fulfilled unless they have a child. The pressure is on married men and women in Africa to have children. The society looks down on a married woman that does not have a child.  In a bid to satisfy society, people go to ridiculous lengths and even destroy their wombs,” she says.

Jegede says this pressure is what drives many women into the hands of quack doctors and pseudo-medical clinics where some contract HIV. She says, “People expect you to give birth nine months after you get married. In fact, one week after a woman gets married, neighbours, friends and colleagues are looking at her stomach to see if it is protruding. That is why women will go through quack fertility treatment and even outright stealing of babies to please the society.

“I heard stories of men getting other women pregnant when their wives could not give them children. In some cases, the husband’s family will introduce him to another woman. Some in-laws would even go as far as bringing another woman into their son’s matrimonial home in the presence of the wife who can’t get pregnant. I didn’t want that to happen to me. I love my husband very much.”

Chinwe Okoro, a boisterous, smiling woman speaks to our correspondent on one sunny Lagos afternoon. She says the pressure on her to conceive was so much that she contemplated buying a child when she couldn’t bear one, after almost three years of marriage.

“The thought of buying a child crossed my mind but my husband would not support it,” she says.

In 2013 alone, the police have burst about 10 “baby-making factories” in Nigeria. These factories are illegal hospitals where teenage pregnant girls are kept and paid fees to bear babies that are eventually sold to barren women for a fee.  In some cases, these factories also got men to get these young women pregnant; they were kept in the factories until they are delivered of the children and then paid off.

When her husband rejected the idea of buying a baby, Okoro also began to visit doctors and herbalist to get help to conceive.

She says, “I went to different places because I wanted to keep my home. My in-laws were not happy with me.  I strongly suspect that I got the virus from the herbalist who gave me several incisions on my body. He promised that with the incisions, I would get pregnant. I did all these for over two years.”

Okoro learnt she was HIV positive when she eventually got pregnant late 2007.

“Initially, I was ecstatic. My husband was full of joy. A child at last! All that joy was punctured when they told me in the hospital that I was HIV positive.

“In fact, I didn’t know anything about HIV until I got the test result. When I got home and told my husband, he was very sad. I’ve never seen him that sad since I’ve known him. He did the test and it showed he was negative.”

Many of the women who contracted HIV while searching for babies say they were shocked when their husbands tested negative to HIV despite having unprotected sex with them. A medical doctor, Dr. Sylvester Ikhisemojie, says studies have shown that some men don’t get as easily infected with HIV as women. According to him, circumcised men who have no injuries on their penises are less likely to get infected with HIV than those who have penile wounds or those who are uncircumcised.

He says, “The prepuce or foreskin is more easily damaged than the skin over a circumcised organ because when it heals, the skin is keratinised and thus acquires some natural imperviousness that is thought to keep out the virus once it remains uninjured.

“However, some of the mechanisms of transmission are unclear and that’s why we may not know why some men don’t get it from their wives. A pilot study is currently going in Kenya to try and understand this. Also, if an HIV positive woman is on antiretroviral treatment, her level of infectivity is diminished, so, she’s of less hazard to her husband.

“With regards to how they got the virus, it’s possible some of the women got it when they visited herbalists and sharp unsterilised objects were used on them.  These places use vey crude methods and safety is the least thing that happens there. This mode of possible transmission is the most sensible to assume because those people do not do any form of sterilisation.

“There was a patient who repeatedly complained about lower abdominal pain, fever, a loss of appetite and profound weakness. A pelvic examination revealed a small rat in her vagina in an advanced stage of decomposition. This was inserted in her body by a herbalist.  She was admitted based on this finding and she battled for her life for over 15 days. She survived but it left her with acquired gynaetresia which narrowed her vagina because of scarring and this probably ended her reproductive carrier. She would need a miracle to get pregnant. The herbalist must have told her that since rats breed in huge numbers, it could bring her reproductive luck.

“Another one allowed a band of spiritualists to have sex with her as part of the healing process designed to ‘remove the evil spirits disallowing her from getting pregnant.’ Four of the spiritualists had intercourse with her during a weekend of ‘prayer,’ without condoms. What if one of them was HIV positive?

Another physician, Dr. Ilesanmi Oluwafunke, explains why it is more difficult for men to contract the virus from their wives. She attributes it to the differences between the male and female anatomies.

She says, “It is very possible for the wife to have the infection and the man does not, and vice versa- we call it sero-discordant couples. Women get the infection more due to the anatomy of the nature of the female organ: wide, copious and can retain semen, while the penile opening is small and doesn’t come in contact with vaginal secretions for so long.

“The likely source of transmission for women who acquire the infection from these unorthodox places is the use of sharps and unsterilised instruments. Incisions and womb washing are some of the wrong procedures performed in such places.

“There are a few who didn’t go in search of children, rather they were taken there in emergencies; ectopic pregnancy, spontaneous abortions, domestic accidents, road traffic accidents, to mention a few. Some of the patients could have decided otherwise but in such times, they were left with no choice.  Some of these health facilities are manned by quacks; laboratory scientists, nurses, paramedics, medical personnel and even some doctors who don’t know about universal precautions. So, what do you expect in such places?”

For Mrs. Adetutu Coker, she had to move out of her estate when she told her best friend that she had contracted HIV. She says the burden of stigmatisation is heavier than that of the victimisation that comes with not having a child.

She says, “I thought I could trust her but she told the whole street. Everywhere I went, people started avoiding me. If I was on one side of the road, I would just find that I would be the only one there. Everyone would cross to the other side of the road. Oh! I almost died of shame.

“My husband who is negative received the same treatment but he stood by me because we were both negative when we got married. I was a virgin. We had to relocate.  If you ask me, HIV does not kill. It’s the stigma that kills.”

However, the Executive Director, Humanity Family Foundation for Peace and Development, which works with women and children living with HIV, says stigmatisation is not as bad as it used to be.

“At HUFFPED, we are actively involved in creating awareness, tracking and providing awareness for women and children living with HIV. Stigmatisation used to be a big problem some years ago, but things are getting better now because of the awareness created. People are now conscious that contracting HIV does not mean a death sentence and that they can live with it. However, government and non-governmental organisations need to do more in terms of creating awareness about the disease.”

For Abah, beyond creating awareness about the virus,the  government needs to make the process of adoption and assisted reproduction easier and easily available.

She says, “We need to be more open about adoption in Nigeria. Apart from government making the adoption process easier, more awareness needs to be created that adoption is not bad. The mentality of Nigerians regarding adoption needs to change.  Most people feel it’s a taboo but we need to realise that you don’t have to give birth to a child to be called a parent.

“Also, assisted reproduction like In Vitro Fertilisation is only for the rich because it’s too expensive (over N1m) and the awareness is low. This needs government’s intervention. If it is affordable, women won’t have to visit quacks or buy babies in order to have children.”

Out of about 15 HIV positive women our correspondent spoke to over a period of three months, none of them knew about IVF until recently.

Chidinma Obiora states that she only got to know about assisted reproduction last year. She says, “I got the virus seven years ago. I was childless and going to different traditional homes. I didn’t know anything about IVF until last year. If I did, maybe I would have tried it.”

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