Health authorities say 70,000 children are born HIV-positive in Nigeria every year, and one-fourth of them don't live past their first birthday. While some officials say they want to make Nigeria one of Africa's first nations to give birth to a generation of HIV-free babies, activists say poverty, stigma and a lack of government support make that goal lofty, if not impossible.
Assumta Reginald was pregnant with her third child when she found out that she is HIV-positive. Back then, she says, programs to prevent mother-to-child transmission of HIV and anti-retroviral drugs were not widely available. There was little for her to do but substitute formula for breast milk, wait and pray.
"All of us were living in fear," Reginald recalled. "So that child was not breast-fed just to avoid the child getting infected. The child is not HIV-positive but the child did not take breast milk."
Reginald says today things are different. She has regular care and is looking forward to breastfeeding another healthy baby when it's born in a few months. But she says many women who are HIV-positive in Nigeria don't take advantage of available pre-natal care.
"Some of them are tested HIV-positive and they are crying. 'My life is finished so my baby is going to be HIV-positive. What am I going to do?' That woman will walk away from the clinic and try to patronize traditional birth attendants. And that woman gets her child infected with HIV," Reginald added.
Edward Ogenyi is the national coordinator for the Network of People Living With HIV/AIDS in Nigeria. He says 2.9 million people are known to be living with HIV in Nigeria, but more than 80 percent of the population does not know their HIV status. And for many who do know, drugs are not available. More than half of the people known to be in need of anti-retroviral drugs in Nigeria don't get them because there are not enough.
"The culture of voluntary counseling and testing is not there. It is something that we are still struggling with," said Ogenyi. "It is only when we can take it up very seriously that we can be sure that we can prevent new HIV infections in this country."
Ogenyi says some women actually avoid public hospitals because of mandatory HIV screening. Dr. Adamu Onu, a family practitioner in Abuja, says stigma attached to being HIV-positive in Nigeria can put women in impossible situations. If a woman does not breastfeed her child, she may make public her HIV status and potentially be ostracized. Worse than that, he says, many women have no choice.
"People expect her to breastfeed and you've told her, 'Well you can't breastfeed your child.' Questions are going to arise," explained Onu. "And then of course she's from a poor background. She cannot afford a breast milk substitute. So what do you do?"
HIV positive women have a 25 percent chance of passing the virus onto their offspring without treatment. Dr. Onu says nearly all the patients who get preventative care have HIV-negative babies. But he says a generation of HIV-free babies is not a realistic goal, because so many rural Nigerians don't have access to health care.
However, Dr. Muhammad Ali Pate, Nigeria's state minister of health, says with expanding health care operations, public education and a proposed new legislation that criminalizes discrimination against HIV/AIDS patients, Nigeria has the capacity to eliminate mother-to-child transmission of HIV.
"It's going be tough, but we can do it," said Pate. "It's not like going to the moon. The interventions are known. We have our resources and we also know our partners have significant resources."
As Reginald prepares to have her fourth HIV-negative child, she says Nigerian HIV/AIDS care relies largely on fickle foreign donors. She calls on the Nigerian government to "take ownership" of the issue to ensure sustainable care.