On March 5, 2020, speakers Dr. Tolu Oladele and Dr. Carl Mhina presented on the topic “Barriers of Access to HIV Treatment” as part of the Center for Global Reproductive Health’s Reproductive Health in Africa Speaker Series, sponsored by the Africa Initiative. Dr. Oladele is an obstetrician and gynecologist from Nigeria, visiting Duke as a Policy Fellow. Dr. Mhina has studied Health Economics and currently works as a researcher in the Department of Population Health Science who works to understand the impact of HIV on different populations.

Dr. Oladele began the presentation speaking about the Prevention of Mother to Child Transmission (PMTCT) of HIV in Nigeria. Only around 50% of expectant mothers are tested for HIV, and attendance at antenatal clinics is low, with around 18% of expectant mothers attending in their first trimester. This inadequate maternal care is in part due to low numbers of facilities that provide such services. In Nigeria, there are approximately 50,000 to 60,000 women with HIV each year, with 40,000 receiving ARV therapy and less than 30,000 infants receiving ARV prophylaxis. By examining government spending, Dr. Oladele noted that Nigeria spends 2 to 3 times less on HIV than other countries and that HIV care, in particular, is highly donor-dependent. The focus behind this funding is more so on treatment and care, rather than prevention, leaving many vulnerable. Because testing is done in a targeted fashion, leaving out pregnant women from its focus, and that those who do get tested encounter numerous fees, many people see getting tested as a burden.

The current issue is that HIV care has been left out of the insurance structure and thus funds are inadequate to properly cover healthcare. In integrating HIV care into Nigeria’s National Health Insurance, funds must be pooled together to pay for healthcare services to prevent catastrophic health expenditures. There is a continued need for donor funding and is an ongoing initiative that will hopefully make a difference in mother and child care.

Dr. Mhina spoke about his work in Tanzania regarding HIV financing. Tanzania is one of the 6 countries with the fastest-growing economies, and one of 9 countries that will drive global population change by 2100. There is a huge education and income gap in the country, with many residents in extreme poverty. Deaths due to HIV are fairly high, as Tanzania is 1 of 10 countries that account for 80% of the global burden of HIV. The disease is more prevalent in women, however, the youth account for 1/3 of new infections.  Similar to the situation in Nigeria, in Tanzania, funding is more geared towards treatment rather than prevention. While the progression of the disease has slowed down, the incidence rate is unaffected. While ARV therapy is free, there are multiple issues barring access, including availability, acceptability, and affordability of overall treatment. In a mixed-method study, Dr. Mhina saw that those of a higher SES tended to receive care in a faith-based clinic, versus those with lower SES status went to state providers. Many encountered stigma from nearby clinics and would have to travel to faraway clinics to feel comfortable, incurring additional costs. Expenditures can pile up, with some spending more than 10% of their income on health.

The financial barriers that prevent people from seeking HIV treatment are large, resulting in many health consequences. As can be seen with the situations in Nigeria and Tanzania, more funding should be placed in HIV prevention in order to reduce the incidence rate, in addition to progression. Both Dr. Oladele and Dr. Mhina provided thought-provoking presentations that add to the discussion of global reproductive health. Be on the lookout for the next lunch talks in Fall 2020!

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