Special Report: Women and Tuberculosis - It's Impact on Nigerian Women living with HIV

Olufunke Osindele, Nigeria
(First published in Ogun Radio, Nigeria on 8th May 2013): As the world marked another International Women’s Day celebrated March 8 every year this gives the world opportunity to reflect on how to ensure equal rights and opportunities for women and girls in terms of access to healthcare, education and social ammenties. According to WHO Tuberculosis (TB), HIV/AIDS and maternal causes, are the three top killers of women of reproductive age globally. TB is a global health burden which countries are trying to control but the good news is that it is curable. It is one of the opportunitistic infections people living with HIV have to battle and this is never a pleasant experience for them especially the women folks.

Amina Alli-Agboola is a young women living with HIV, she works with Nigeria Business Coalition Against AIDS NiBUCAA as the Project and Personal Assistant to Executive Secretary. She is one of the few who were able to access treatment and endure the trauma associated with getting a cure especially as an HIV positive woman.

Amina said “In early 2004, I was very sick and after much diagnosis, my family doctor couldn’t find anything wrong with me. He suspected tuberculosis (TB) and referred me to Mainland Hospital, Lagos but they could not detect tuberculosis. I was later asked to go for an HIV test at Salvation Army Hospital. When the result came, I was HIV positive, but the TB symptoms still persist. From Salvation Army I was referred to AIDS Alliance in Nigeria (AAN), a support group of people living with HIV, because they do not offer counseling at that time. I was referred to Nigerian Institute of Medical Research (NIMR) where I will be treated for HIV.

At AAN, I was referred to St. Kizito Ajah that was where my TB was detected and treated. I had to go through 6 months intensive drug treatment. I had to go to Ajah from Surulere everyday to take my medication. I was only given medication for a week when I was writing my exams in school. It was hectic assessing medication daily. Although I was very sick with other opportunistic infection, I was not given ARV until December 2004 because the doctor said the TB medication will react with ARV, so they waited till I was certified ok at St. Kizito.

Amina said. “For me, TB was a bad experience, having night’s sweats, losing weight, not been able to drink cold water when you are tasty and not eating together with my sister’s children was not easy for me. But with love of God, my family members and the treatment I got, I overcame the bad and sad experience”.

Patient Agbaji is also a young woman living with HIV who was cured of TB, former care provider for orphans and vulnerable children at Nigeria Institute of Medical Research (NIMR). She shared with JAAIDS the experience of how she was cured of TB. She said “I was once a patient at the DOTS clinic in NIMR where I was diagnosed for TB in April 2009. I rounded up my treatment by November; it was an eight months treatment. The first time I went for the TB test, my sputum was collected three times before I was diagnosed with tuberculosis. The nurse explained that the treatment will take 8 months so I asked if the TB will completely be cured after the treatment and she assured me it will. However she added that I should not miss my drugs despite the side effects. After three months I felt much better and I was reluctant to pick my drugs but the nurse encouraged me to complete the treatment. In between the treatment, another sputum test was carried out and the last one at the end of the treatment to certify that the TB was completely cured”.

Low TB detection rates and poor treatment rates are still an issue in developing countries. Early detection and effective cure protocol are important determinants of disease control but notification rates are higher in men than women in most countries as lack of mobility, poverty, and heavy workload of women restrict them from access to health care facilities.

Nigeria as a developing country has one of the highest tuberculosis (TB) burdens in the world (311 per 100,000), resulting in the largest burden in Africa. According to USAIDS report on Nigeria, the country has a rising TB detection rates and program coverage but many TB cases are still undetected. The high rates of TB/HIV co-infection result in a significant health challenge in the HIV/AIDS response.

TB/HIV co-infection is not the only issue Nigeria has to tackle as the country still has many undetected cases, there is also the issues of Multi Drug Resistance TB. Senior clinician with the Nigerian Institute of Medical Research (NIMR), Dr. Dan Onwujekwe noted that patients are dropping out of TB treatment. He explained that patient dropping out of the treatment programme is a big problem in TB treatment which is a hinderance to the effective use of the key drugs or first line drugs. This according to him has led to another epidemic outbreak of Multi Drug Resistance TB (MDR TB). He noted that this form of TB is costly and it takes 24 months to treat, 8months as an in-patient at the facility and 12months as outpatient. It is therefore preferable to treat and cure TB within 8months as there are few standard facilities established in the country for the treatment of MDR TB.

However a major problem he noted is the fact that some patients when diagnosis for MDR TB do not want to stay 8months on admission and these ones are lost to treatment that they required to get cured.

Medical experts have described TB is an airborne infectious disease which is curable and women experience different risk factors, social and economic consequences as well as barriers to treatment than men (Baral & Karki, 2007).[2] This is due to the fact that tuberculosis has been linked with poverty, because of its relation with weakened immune system due to poor nutrition as well as tendency of living in crowded homes which is a major issue in the urban and sub-urban areas in Nigeria. TB marginalizes people both from social and economic point of view, experiencing social isolation both within their own family and outside of it. In addition, women living with HIV/TB co-infection encounter stigma and discrimination. This in most cases has contributed to delayed diagnosis and treatment. The stigma of both diseases and their resultant discrimination impacts their control programmes, because a patient who is afraid of being identified as a sick person is likely to delay proper treatments for both diseases.

Project Director at the International Union Against Tuberculosis and Lung Disease (The Union), India, Dr Sarabjit Chadha in a recent interview with international journalists said there is need to target women more specifically. According to her activities are actually not ‘gender specific’. “We do not take cultural issues into consideration in devising any interventions. Let’s say there is a microscopy center which is located 20 kms away from the village. Men can take public transport and somehow access this microscopy center although with some difficulty because they go out for work. But for a woman it becomes all the more difficult because (i) she is not educated (ii) she is economically dependent and (ii) she may not feel comfortable going out alone and accessing these services”.

She added that accelerating and intensifying case finding would involve creating awareness amongst the women. This is basically because the woman runs the family, so if anyone in the family (including the children or the husband or the in-laws) has cough for 2 weeks or more she could be the one who could influence positive action. Dr. Chadha also said “Secondly, we need to bring the services to their doorstep rather than expect these women to come out and travel long distances to access health services. We need to have interventions which improve access. This could be related to sputum collection, transportation or active case finding—all of which will help in reducing delay for TB diagnosis.

Olufunke Osindele, Nigeria 
Citizen News Service - CNS
(First published in Ogun Radio, Nigeria on 8th May 2013)

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